外伤性虹膜缺如眼植入虹膜隔人工晶状体后的远期并发症

Long term complications of black diaphragm aniridia intraocular lens implant in traumatic aniridia

目的分析外伤性虹膜缺如患者植入虹膜隔人工晶状体后的远期并发症，探讨其发生原因及预防措施。方法回顾性系列病例研究。回顾性分析因外伤性虹膜缺如在山东省眼科研究所青岛眼科医院行虹膜隔人工晶状体植入术并在长期随访过程中出现严重并发症的5例患者的资料，归纳其临床特点。其中男性4例，女性1例，年龄13～43岁，随访时间42～108个月。2例于睫状体扁平部玻璃体切除术后行Ⅱ期虹膜隔人工晶状体悬吊术，2例I期行白内障摘除联合虹膜隔人工晶状体植入术，1例行虹膜隔人工晶状体悬吊术。结果所有患者短期随访主观感觉良好，眩光、畏光症状消失，并在一定时期内维持较好的视力。在长期随访过程中均出现了严重的继发性青光眼和大泡性角膜病变，视力下降至指数或手动，并接受穿透性角膜移植和人工晶状体取出术治疗。结论虹膜隔人工晶状体植入术后可能出现严重的远期并发症，应慎重选择手术适应证，并加强对患者的随访。

Objective To analyze long-term complications of black diaphragm aniridia intraocular lens （IOL） implant in traumatic aniridaia and to investigate the causes and precautionary measures. Methods This is a retrospective consecutive case study. Five traumatic aniridia cases undertaken black diaphragm aniridia IOL implantation in Shandong Eye Institute and Hospital and developed severe complications during long-term follow-up were analyzed, including 4 males and 1 female, averaged 26.8 years old. The follow-up time varied from 42 months to 108 months. Two cases had implantation of a secondary black diaphragm IOL after pars plana vitrectomy. Two cases had implantation of a black diaphragm IOL together with cataract extraction. One case implanted a black diaphragm IOL only. Results All patients felt well within a short period after the surgery, symptoms of glare and photophobia were improved. A better visual acuity was obtained in a short-term period. However, severely secondary glaucoma and bullous keratopathy occurred in the long-term follow up. Visual acuity decreased to counting finger or hand motion. All cases received penetrating keratoplasty and IOL explantation. Conclusions Black diaphragm aniridia intraocular lens implantation may induce severe long-term complications. The indications should be selected seriously and closely follow-up is important.