着色聚甲基丙烯酸甲酯人工晶体在白内障及角膜移植三联术中的应用

Application of colorized polymethyl methacrylate intraocular lens in trigeminal operations of cataract extraction and corneal transplantation

目的:目前在白内障摘除人工晶状体置入角膜移植三联术中对人工晶体的选择在不断改进。在小切口非超声乳化白内障摘除、人工晶体置入联合角膜移植三联术中置入着色聚甲基丙烯酸甲酯人工晶体并评价其对视力的改善效果。方法:由第一作者以"着色人工晶体,穿透性角膜移植,白内障,联合术"为检索词,在中国期刊全文数据库(CNKI:2003/2007)中进行文献检索,语言设定为中文。以"PMMA intraocular lens,cataract extraction,corneal transplantation"为检索词,在Medline database(1974/2004)数据库中进行文献检索,语言设定为英文。选择主题内容与白内障及角膜移植三联术中着色聚甲基丙烯酸甲酯人工晶体置入联系紧密的文章,排除Meta分析、与主题无关的文章及重复性研究。共纳入11篇文章,针对病例进一步归纳总结。结果:作者结合上述文献利用着色聚甲基丙烯酸甲酯人工晶体置入治疗外伤或各种眼病引起的角膜白斑合并白内障病例21例(21眼),随访时间10个月。92%患者着色聚甲基丙烯酸甲酯人工晶体置入后裸眼视力比置入前提高,置入后2周视力在4.7以上有9例占42.9%,4.5以上有10例占47.6%,视力为4.0有2例占9.5%。置入后7～14d,21眼角膜植片全为透明。置入后10个月植片完全透明16例,植片呈半透明3例,角膜重度混浊并需再次行穿透性角膜移植2例。结论:针对病例并结合文献得出结论,穿透性角膜移植联合白内障摘除、人工晶体置入三联术中置入着色聚甲基丙烯酸甲酯人工晶体,可以一次性解决眼前段屈光间质混浊。与传统联合术相比,三联术减少了术后并发症,使患者快速恢复术后视力,安全性高。

OBJECTIVE：Intraocular lens are applied in trigeminal operations of cataract extraction and corneal transplantation,and the selection of artificial lens is modified.This paper evaluated the application of colorized polymethyl methacrylate（PMMA） intraocular lens in interlaced non-phacoemulsification cataract extraction with intraocular lens implantation and keratoplasty（trigeminal operation）.METHODS：A computer-based online search of CNKI（2003/2007）and Medline database（1974/2004）was performed for related articles with the key words ＂colorized intraocular lens,corneal transplantation,cataract,combination operation＂in Chinese and ＂PMMA intraocular lens,cataract extraction,corneal transplantation＂in English.Articles related to PMMA intraocular lens in cataract and corneal transplantation trigeminal operation was selected.Meta analysis and repetitive articles were excluded.A total of 11 articles were included and summarized.RESULTS：A total of 21 cases（21 eyes）of corneal leukoma and cataract caused by various trauma or ophthalmopathy underwent colorized PMMA intraocular lens implantation.During the follow-up for 10 months,visual acuities of naked eyes in 92% cases were significantly improved.Two weeks after operations,visual acuities of 9 cases（42.9%） were over 4.7,10 cases over 4.5,and 2 cases（9.5%） over 4.0.At days 7 to 14 after operation,corneal grafts of 21 cases were completely transparent;10 months after operation,corneal grafts of 16 cases were completely transparent,3 cases were semitransparent,and 2 cases were turbid,who underwent second penetrable corneal transplantation.CONCLUSION：The application of colorized PMMA intraocular lens in penetrable corneal transplantation combined cataract extraction can cure the refracting media turbidity of forepart eye.Compared with traditional operations,trigeminal operation reduces complications,increases safety and improves visual acuity.