巩膜缝线固定后房型人工晶状体术后低眼压的处理

The management of ocular hypotony after posterior chamberscleral-sutured intraocular lens implantation

目的探讨复杂性视网膜病变及严重眼外伤进行晶状体切除及玻璃体切除术的患者，Ⅱ期巩膜缝线固定人工晶状体植入术后低眼压的发生原因及其处理方法。方法回顾性分析于2003年6月至2004年12月作者早期开展Ⅱ期巩膜缝线固定人工晶状体植入术共34例（34眼），其中3眼是虹膜隔型人工晶状体，6眼同期行虹膜修补瞳孔成形术。结果本组34眼中有8眼（23．53％）术后发生低眼压，其中4眼为一过性低眼压，术后5～7d前房黏弹剂再注入后，眼压逐渐恢复正常；另4眼伴有脉络膜脱离，其中3眼经皮质类固醇治疗后眼压恢复，1眼术后10d行脉络膜上腔放液及注气术，眼压恢复。术后视力提高者32眼（94．1％）。随访6～18个月，人工晶状体均无明显倾斜偏位，视网膜脱离无复发。结论对于复杂性视网膜病变及严重眼外伤进行晶状体切除及玻璃体切除的患者，Ⅱ期巩膜缝线固定人工晶状体植入，术后低眼压是较易发生的并发症，经治疗可以恢复。

Objective To investigate the cause and management of ocular hypotony after posterior chamber scleral - sutured intraocular lens （IOL） implantation in aphakic eyes which had undergone lensectomy and vitrectomy for complicated retinal disease or severeoeular trauma. Methods A retrospective chart review was conducted in 34 patients （34 eyes） who had posterior chamber seleral-sutured IOL implantation between June, 2003 and December, 2004. Among them, 3 eyes were implanted with aniridia IOLs and 6 eyes had coreoplasty at the same time. Results Postoperative hypotony occurred in 8 eyes （23.5%）. Hypotony in 4 eyes was temporary and the intraoeular pressure （lOP） rose back to norreal with injection of sodium hyaluronate into the anterior chamber 5-7 days postoperatively. 3 eyes developed choroidal detachment and hypotony was settled after treatment with local and systemic steroids. Only 1 patient failed to respond to the nledical treatment. In this case the suprachoroidal fluid was drained through a sclerotomy with injection of sterile air into the vitreous cavity 10 days after IOL implantation and hypotony resolved eventually. Postoperative best corrected visual acuity of all patients improved and IOP stable. All the IOLs were well centered and no recurrent retinal detachments were encountered over the follow-up period of 6-18 months. Conclusions For a beginner of the surgery of posterior chamber scleral-sutured IOL implantation, ocular hypotony is a common complication in eyes which had undergone lensectomy and vitrectomy for complicated retinal disease or severe ocular trauma.