人工晶状体脱入玻璃体的原因及手术处理

Surgical management and cause of intraocular lens dislocation into the vitreous

目的探讨前房型和后房型人工晶状体脱入玻璃体的原因及处理的方法。方法共17例(17眼)。后房型人工晶状体脱位14眼,前房型人工晶状体脱位3眼。钝挫伤后人工晶状体脱位6眼,白内障术中或术后人工晶状体脱位11眼。根据不同情况行(1)玻璃体切除,人工晶状体摘出及人工晶状体(更换)再植入术。(2)玻璃体切除、人工晶状体摘出及后房人工晶状体睫状沟缝线固定术。(3)玻璃体切除、人工晶状体摘出及人工晶状体(更换)再植入并视网膜复位术。观察术前和术后视力及并发症情况,术后随访3～18个月。结果摘出人工晶状体17片,襻长12.5mm光学直径5.5mm的有12片占70.59%。有16例人工晶状体(更换)再植入睫状沟或巩膜悬吊术。术后视力0.02的1眼,0.1～0.2的3眼,0.3～0.5的13眼,无严重并发症发生。结论晶状体后囊破裂或悬韧带断裂后,植入襻长较短和光学直径小人工晶状体是人工晶状体玻璃体腔脱位的原因之一。玻璃体切除后摘出脱位人工晶状体,再植入合适的人工晶状体是处理人工晶状体玻璃体脱位的有效的方法。

Objective To discuss the causes of the anterior and posterior chamber intraocular lenses （IOLs） dislocation and the surgical manipulation for those condition. Methods In the 17 cases （17 eyes） of IOLs dislocation into vitreous cavity, 14 eyes was the posterior chamber intraocular lenses and 3 eyes was the anterior chamber intraocular lenses. Intraocular lens doslocated after blunt trauma in 6 eyes, and during or after cataract surgery in 11 eyes. Three kinds of surgical methods were applied according to the different situation, （ 1 ） vitrectomy combined with IOLs extraction and IOLs reimplantation. （2）vitrectomy combined with IOL extraction and IOLs suture fixation. （3）vitrectomy, IOLs extraction, IOLs reimplantation combined with retina reposition surgery. The visual acuity and the complications were fellowed-up for 3 - 18 months. Results In 17 pieces of IOLs extracted, loops diameter 12.5 mm and optics diameter 5.5 mm in 12 pieces （70. 59% ）. 16 cases undergone IOLs reimplantation or suture fixation into the ciliary sulcus. The visual acuity were 〈0. 2 in 1 eye, 0. 1 -0. 2 in 3 eyes, 0. 3 -0. 5 in 13 eyes. Conclusion After the posterior capsule rupture or the ligament of lens broken, short loops and small optics of IOLs is one of causes of dislocation, it is an effective mentod that IOLs reimplanted after vitrectomy and extraction of dislocated IOLs.