瞳孔成形联合人工晶状体植入术的临床研究

Clinical study on coreoplasty combined with IOL implantation

目的探讨27例(29眼)虹膜瞳孔异常合并白内障、晶状体脱位或无晶状体眼患者行瞳孔成形联合超声乳化人工晶状体植入术的手术技巧及临床疗效。方法回顾性分析我院自2006年12月至2008年12月诊治的27例(29眼)患者的临床资料,均为多种原因导致的伴有虹膜瞳孔异常的白内障、晶状体脱位或无晶状体眼,并行瞳孔成形联合白内障超声乳化人工晶状体植入和(或)前段玻璃体切割术。术后随访6～9个月,平均7.8个月。结果术后25眼视力提高,患眼瞳孔呈圆形或类圆形,瞳孔位于中央或近中央24眼,瞳孔偏位5眼。术中1眼玻璃体积血,3眼前房出血;术后3眼眼压升高;1眼术后2个月发生视网膜脱离。结论瞳孔成形联合人工晶状体植入术,在提高视力的同时,能消除羞明、眩光的症状,最大程度适应自然光线,提高视觉质量。手术关键在于术前准确评价虹膜弹性和伸展性,利用黏弹剂、各种眼内显微器械和缝线恢复虹膜晶状体隔,根据眼部条件选择植入人工晶状体的方式。

Objective To evaluate the therapeutic effects and surgical techniques of coreoplasty combined with intraocular lens（IOL）implantation for 27 cases（29 eyes）with pupil abnormality and cataract,luxation of lens or aphakia.Methods In this retrospective study,29 eyes of 27 patients,accompanying with pupil abnormality and cataract,luxation of lens or aphaki caused by various reasons,were treated with coreoplasty combined with IOL implantation and（or）vitrectomy of anterior segment from December 2006 to December 2008 in our hospital.All patients were followed up for 6 months to 9 months,averaging in 7.8 months.Results Visual acuity improved in 25 eyes postoperatively;Pupils of eyes with disease were with round or nearly round shape;Pupils of 24 eyes were at central or nearly central position,and 5 eyes with pupil displacement.Vitreous hemorrhage occurred in 1 eye and hyphema occurred in 3 eyes intraopera-tively.Intraocular pressure of 3 eyes increased postoperatively.There was 1 eye with retinal detachment at postoperative 2 months.Conclusions Besides improving visual acuity,coreoplasty combined with IOL implantation can also eliminate phengophobia and glare,adapt for natural light to biggest extent,and improve visual quality.The key points of surgical technique are accurately evaluating the iris elasticity and stretchability preoperatively,using viscoelastic agents,all sorts of intraocular microscopic devices and suture line to recover crystal diaphragm of iris,and choosing the way of IOL implantation according to ocular conditions.