白内障超声乳化术中经巩膜缝合后房型折叠人工晶状体的应用

Clinical research on trans-scleral suture of foldable posterior intraocular lens during phacoemulsification

目的观察折叠人工晶状体应用于白内障术中悬吊缝合的安全性和有效性。方法收集白内障术中由于后囊膜破裂或晶状体悬韧带离断范围过大,需要进行人工晶状体悬吊固定的患者,随机行CZ70BD型聚甲基丙烯酸甲酯(ploymethyl-methacrylate,PMMA)材料和折叠材料人工晶状体缝合固定。其中PMMA人工晶状体组11例(11眼),折叠人工晶状体组12例(12眼)。比较观察2组术中及术后并发症、术后眼压、术后人工晶状体位置、术后1个月的屈光情况和最佳矫正视力。结果2组患者术中均有1例发生了出血,2组比较差异无统计学意义(χ2=0.457,P=0.481)。术后1d,PMMA人工晶状体组有3例、折叠人工晶状体组有2例眼压低于正常值10mmHg(1kPa=7.5mmHg),经药物治疗后均在术后7-10d眼压恢复至正常范围,2组差异无统计学意义(χ2=0.025,P=0.912)。术后PMMA人工晶状体组光学部倾斜或偏位的有2例,折叠人工晶状体组光学部倾斜的有2例,2组差异无统计学意义(χ2=0.374,P=0.537)。2组术眼术后均无眼内炎、角膜失代偿或视网膜脱离的发生。PMMA人工晶状体组术眼术后1个月的平均等效球镜度数(1.75±0.82)D,折叠人工晶状体组为(0.96±0.51)D,PMMA人工晶状体组屈光不正较折叠人工晶状体组高,2组比较差异有统计学意义(t=1.796,P=0.043)。2组术后1个月的最佳矫正视力比较差异无统计学意义(χ2=0.983,P=0.801)。结论折叠材料的人工晶状体应用于白内障术中悬吊缝合具有较好的安全性和有效性,较PMMA材料的人工晶状体有更理想的术后屈光效果。

Objective To investigate the safety and efficacy of trans-scleral suture of foldable intraocular lens（IOL） during phacoemulsification.Methods The patients who were with posterior capsular rupture,a large extent of lens ligamentum suspensorium fragmentation and needed to taken suspension suture of IOL,were performed with trans-scleral suture of IOL with CZ70BD PMMA material or foldable material randomly.There were 11 cases（11 eyes） with PMMA IOL and 12 cases（12 eyes） with foldable IOL.Intraoperative and postoperative complications,postoperative intraocular pressure（IOP）,postoperative IOL location,diopter and best corrected visual acuity at postoperative 1 month were observed.Results One patient in each group occurred bleeding intraoperatively,there was no significant difference between two groups（χ2=0.457,P=0.481）.IOP of 3 cases in PMMA IOL group and 2 cases in foldable IOL group were lower than normal level 10 mmHg（1 kPa=7.5 mmHg） at postoperative 1 day.These eyes recovered to normal level after drug treatment at postoperative 7 days to 10 days（χ2=0.025,P=0.912）.Two cases in each group showed optical dyssymmetry postoperatively（χ2= 0.374,P=0.537）.No endophthalmitis,corneal decompensation or retinal detachment occurred in both groups postoperatively.The average spherical equivalence was（1.75±0.82）D in PMMA IOL group and（0.96±0.51）D in foldable IOL group at postoperative 1 month.Ametropia was more serious in PMMA IOL group than in foldable IOL group（t=1.796,P=0.043）.There was no significant difference for the best corrected visual acuity between the two groups at postoperative 1 month（χ2=0.983,P=0.801）.Conclusion The foldable posterior chamber IOL can be trans-scleral sutured safely and effectively during phacoemulsification,which have more ideal postoperative refraction effects than PMMA IOL.