外伤性白内障人工晶体植入术临床分析及术式选择

Clinical observation of traumatic cataract intraocular lens implantation and choice of operation methods

为探讨人工晶体植入手术方法和术式选择，对７２例（７３眼）外伤性白内障晶体囊膜损伤情况分类，其中完整型２１例（指手术时前后囊膜无破裂）。囊膜破裂型３５例（其中前后囊膜均破裂３２例），无晶体眼１０例（其中后囊膜完整４例，无后囊膜６例），晶体半脱位６例。３例植入ＡＣ—ＩＯＬ，４３例后囊膜完整或后囊中央破口＜５ｍｍ，周边破损＜１２０°。常规法植入ＰＣ—ＩＯＬ，２６例后囊膜破损超过上述范围，在处理好玻璃体的同时行ＰＣ—ＩＯＬ缝线固定术。术后３个月矫正视力＜０．５的有２４例（３３．３％），０．５～１．０的有３２例（４４．４％），＞１．０的有１６例（２２．２％），缝线固定术较常规ＰＣ—ＩＯＬ植入术更易造成眼内出血，人工晶体旋转移位及视网膜脱离，术后反应较重。结论：本文通过对７２例外伤性白内障分析，将眼外伤后晶体囊膜损伤分类，探讨提高手术成功率的方法，提示截囊时尽可能保留前囊膜，以备后囊膜破损较大时代替后囊膜做支托植入ＰＣ—ＩＯＬ，对后囊膜中央破口＜５ｍｍ，周边破损＜１２０°，可按常规法植入ＰＣ—ＩＯＬ，如后囊膜破损超过上述范围。

Objective:To get the injured capsules of 72 eyes with various types of traumatic cataract classified,to investigate a method of intraocular lens implantation and choice of operation methods.Methods:72 eyes with traumatic cataract were divided into 4 groups:(1)21 eyes with complete capsules (anterior and posterior capsules did not rupture in operation);(2)35 eyes capsules ruptured (32 of 35 eyes anterior and posterior capsules ruptured);(3)10 eyes with aphakia (4 of 10 eyes posterior capsules were complete,6 of 10 eyes posterior capsules were absent);(4)6 eyes with partial dislocation of the lens.3 eyes were performed AC IOL implantation.43 eyes that posterior capsules were complete or central posterior capsular ruptare was<5mm and peripheral capsular rupture<120° were performed PC IOL implantation routinely.26 eyes that posterior capsular rupture were larger than that of were perfromed PC IOL implantation with scleral fixation and vitreous were managed at the same time.Results:3 months after the operation,corrected visual acuity was<0 5 in 24 eyes(33 3%),0 5～1 0 in 32 eyes (44 4%)>1 0 in 16 eyes (22 2%),scleral fixation made intraocular hemorrhage and IOL decentralization and retineal detachment easier than routine PC IOL implantation.Operation reaction was more severe.Conclusion:Throngh investigation of 72 eyes with traumatic cataract,got injured capsules classified,to discuss a method of improving success rate of operation,and point out that anterior capsule should be preserved as far as possible when capsulorhexis.so that it replaced posterior capsule for PC IOL implantation in case that posterior capsule ruptured largely.when central posterior capsular rupture was <5mm,peripheral posterior capsular rupture<120°,PC IOL implantation were performed routinely,when posterior capsular rupture was larger than of,PC IOL implantation were performed with scleral fixation.