前玻璃体切除联合四点固定推注人工晶状体悬吊术

Anterior vitrectomy and injective four-sites fixed intraocular lens implantation

目的:探索表面麻醉前房灌注下透明角膜切口前玻璃体切除术联合四点固定推注人工晶状体悬吊术的临床疗效及安全性。方法:对我院2004-03/2006-12各种原因所致需要悬吊人工晶状体患眼51眼,在表面麻醉下通过2.8mm透明角膜切口,在前房灌注下用前玻璃体切除器处理瞳孔区机化膜及玻璃体后,巩膜外入路睫状沟四点固定Rayner Superflex推注式丙烯酸人工晶状体。结果:51例患者均在表面麻醉下顺利完成手术,有7眼术中加用一次表面麻醉药,无1例改变麻醉方法。手术时间15.12～40.80(平均20.83)min。术后视力提高5行以上者25眼(49.02%);3行以上者42眼(82.35%);1行以上者49眼(96.08%);2眼提高不明显,但诉较前清楚。对眼底检查无明显影响。结论:表面麻醉前房灌注下透明角膜切口前玻璃体切除术联合四点固定推注人工晶状体悬吊术治疗无晶状体眼安全、快捷、疗效确切,是治疗各种原因所致无囊膜支撑需悬吊人工晶状体的最佳手术方案之一。

AIM： To investigate the clinical effect and safety of anterior vitrectomy and injective four-sites fixed intraocular tens （IOL） implantation through clear corneal incision with anterior chamber irrigation under topical anesthesia. METHODS： From March 2004 to December 2006, 51 patients （51 eyes） underwent suspended IOL implantation. During the surgery, the Rayner Superflex injective acrylic IOL was fixed in the ciliary sulcus on four sites through 2.8mm clear corneal incision by extra-sclera procedure after the fibrous membrane and vitreous in the pupil area were removed by anterior vetrectomy technique under topical anesthesia. RESULTS： All the surgeries were completed successfully. Of them, 7 eyes were added topical anesthetics once again, and anesthetic method was not changed. The operation time was measured in all the patients （ ranging from 15.12 minutes to 40.80 minutes, mean time 20.83 minutes）. The postoperative visual acuity was improved more than 5 lines in 25 eyes （49.02%）, more than 3 lines in 42 eyes （82.35%）, more than 1 line in 49 eyes （96.08%）, and of no changes in 2 eyes. The patients whose visual acuity had no improvement complained they saw things more clearly than before. The lenses had no obvious effects on the fundus examination. CONLUSION ： The anterior vitrectomy and injective foursites fixed intraocular lens implantation through clear corneal incision with anterior chamber irrigation under topical anesthesia is a safe, effective operative method, and can be used to treat the aphakic eye without capsule supporting.