两种后房型人工晶体四点法睫状沟缝线固定联合玻璃体切除术的临床观察

Two techniques of posterior chamber intraocular lens(IOL) implantation by a 4-point ciliary sulcus suture fixation technique combined with vitrectomy

目的:观察两种后房型人工晶体行四点法睫状沟缝线固定联合玻璃体切除术,探讨其适用性、可行性、安全性和有效性。方法:对23例复杂性眼外伤患者行晶状体、玻璃体切除联合后房型人工晶体四点法睫状沟缝线固定手术。其中9例为眼球破裂伤、玻璃体积血、视网膜挫伤合并外伤性白内障患者,6例为眼球破裂伤、玻璃体积血、视网膜挫伤、球壁异物合并外伤性白内障患者,8例为眼球钝挫伤、玻璃体积血合并外伤性白内障晶状体脱位患者。随机选用两种人工晶体,其中组12例选用Alcon CZ70BD一片式PMMA悬吊式人工晶体,组11例选用Bausch&Lomb AkreosAdapt四襻固定亲水性丙烯酸折叠式人工晶体。完成玻璃体切除,球壁异物取出和/或晶状体摘除术后,所有患者均一期植入后房型巩膜固定人工晶体,采用四点巩膜缝线固定技术,调整缝线使人工晶体位于中心,缝线结转出眼外,包埋于巩膜板层中。结果:所有患者平均随访时间为(12.4±1.7)月。组11例(91.7%)术后视力较术前有不同程度的提高,1例(8.3%)不变,术后最佳矫正视力≥0.5者3例(25.0%)。组11例(100%)术后视力较术前有不同程度的提高,术后最佳矫正视力≥0.5者4例(36.4%)。两组所有患者术后人工晶体无明显偏位、无倾斜。结论:两种后房型人工晶体四点法睫状沟缝线固定联合玻璃体切除术治疗复杂性眼外伤,均能有效、迅速地使患者恢复视功能,并且具有较高的安全性。两种后房型人工晶体由于其不同的特性各有其优缺点,可根据不同病情有选择地使用。

Objective： To observe the results of two techniques of posterior chamber intraocular lens （IOL） implantation by a 4-point ciliary sulcus suture fixation combined with vitrectomy. Methods： Lensectomy and vitrectomy combined with posterior chamber IOL implantation by a 4- point scleral fixation was performed in 23 cases with complicated ocular trauma,including 9 eyes had eyeball rupture,vitreous hemorrhage,retinal contusion and traumatic cataract; 6 eyes having eyeball rupture, vitreous hemorrhage, retinal contusion, intraocular foreign body and traumatic cataract; 8 eyes having ocular blunt trauma, vitreous hemorrhage, traumatic cataract and lens dislocation. Two techniques of IOL were randomly assigned. Alcon CZTOBD PMMA suspensory IOL was performed in 12 cases （Group Ⅰ ）; Bausch ＆ Lomb Akreos Adapt four-haptic hydrophilic acrylic foldable IOL was performed in 11 cases （Group Ⅱ ）. After completed vitrectomy, removed intraocular foreign body and （or） cataract extracted, one-stage IOL implantation by 4-point scleral fixation was performed and the knots of fixation sutures were rotated and buried under the sclera for all patients. The IOL position was adjusted by suture for the best centration. Results： The mean follow-up time was （12.4 ± 1.7） months. The postoperative best-corrected visual acuity （BCVA） was improved in 11 cases （91.7%） of Group Ⅰ ; and BCVA was ≥0. 5 in 3 patients （25.0%）. The postoperative BCVA was improved in 11 cases （100%） of Group Ⅱ ; and BCVA was ≥0. 5 in 4 eyes （36. 4%）. There was no IOL decentration or tilting in two groups. Conclusions： Lensectomy and vitreetomy combined with posterior chamber IOL implantation by a 4-point scleral fixation technique is a good method to treat complicated ocular trauma. Two techniques of posterior chamber IOL have both advantages and disadvantages,and can be used accordingly.