晶状体囊袋张力环植入在高度近视眼白内障超声乳化吸除人工晶状体植入术中的应用价值

Application capsular tension ring in phacoemulsification and IOL insertion surgery for hypermyopia patients with cataract

目的评价晶状体囊袋张力环(CTR)植入在高度近视眼白内障超声乳化吸除联合低度数人工晶状体手术中的应用价值。方法将827例(1081只眼)高度近视眼白内障患者随机分为A、B两组,A组427例(549只眼),B组400例(532只眼),其中A组患者行白内障超声乳化吸出术及后房型人工晶状体和CTR植入,B组患者仅行白内障超声乳化吸出术及后房型人工晶状体植入,所有患眼术后均随访18个月,测视力、眼压,散大瞳孔进行眼前节裂隙灯观察照像。结果所有植入的人工晶状体均位于正位,A组术后3个月矫正视力>0.8者43只眼,0.6～0.8者118只眼,0.5者89只眼,0.4者101只眼,0.3者66只眼,0.2者80只眼,<0.2者52只眼;术后第1天眼压为3～47mmHg,一过性高眼压179只眼,其中有1只眼因术后高眼压无法药物控制而取出CTR;随访18个月中有2只眼发生视网膜脱离。B组术后3个月矫正视力>0.8者40只眼,0.6～0.8者110只眼,0.5者83只眼,0.4者95只眼,0.3者69只眼,0.2者83只眼,<0.2者52只眼;随访18个月中有9只眼发生视网膜脱离。两组的视网膜脱离发生率比较差异均统计学意义。结论 CTR在高度近视眼白内障超声乳化吸除联合低度数人工晶状体手术中的应用能防止晶状体悬韧带离断,使人工晶状体居中性更佳,并能有效防止视网膜脱离的发生。

Objective To observe the effects of capsular tension ring on retinal detachment formation in hypermyopia patients received phacoemulsification and IOL insertion.Methods One thousand and eighty-seven eyes of 827 hypermyopia patients with cataract were divided two group,group A：five hundred and forty-nine eyes of 427 patient were randomly selected for phacoemulsification and IOL insertion and capsular tension ring insertion,group B：five hundred thirty-two eyes of 400 patient was assigned to a phacoemulsification and IOL insertion.During 1~18 months＇ follow-up,visual acuity,intraocular pressure（IOP）and the anterior segment of eyes were measured by slit lamp microscope and used the CAAS software to analyze the retinal detachment formation.Results No IOL decentration was found.Postoperative.at two group.The group A visual acuity with correction greater than 0.8 with 43 eyes,0.6~0.8 with 118 eyes,0.5 with 89 eyes,0.4 with 101 eyes,0.3 with 66 eyes,0.2 with 80 eyes,less than 0.2 with 52 eyes at 3 months postoperatively.Intraocular pressure（IOP）of 549 eyes was 3~47 mm Hg at first day postoperatively,increase of IOP was found at 179 eyes only a short time.CTR was removed from intraocular in 1 eye due to IOP increase beyond control.Retinal detachment was found in 2 eyes at 18 months postoperatively.The group B visual acuity with correction greater than 0.8 with 40 eyes,0.6-0.8 with 110 eyes,0.5 with 83 eyes,0.4 with 95 eyes,0.3 with 69 eyes,0.2 with 83 eyes,less than 0.2 with 52 eyes at 3 months postoperatively,Retinal detachment was found in 9 eyes at 18 months postoperatively.SPSS software analysis had statistical significance on retinal detachment formation postoperatively in two group.Conclusion The CTR in high myopia cataract surgery associate with intraocular lens implantation operation can prevent zonular dehiscence and IOL decentration and tilt,and may lead to reduce retinal detachment.