外伤性无晶状体眼二期后房型人工晶状体植入术

Secondary implantation of posterior chamber IOL for traumatic aphakia

目的探讨外伤后无晶状体眼的二期后房型人工晶状体植入的手术方法和疗效。方法对58例(58眼)外伤性无晶状体眼行二期后房型人工晶状体植入术。其中50例伴有不同程度眼前段结构紊乱,同时行眼前段重建,包括虹膜粘连松解、虹膜根部离断缝合、瞳孔成形、以及瞳孔区机化膜切开等。8例晶状体玻璃体切除术后的无晶状体眼,应用玻璃体腔放置灌注管维持眼压。结果均顺利植入后房型人工晶状体,术后随访5～24个月。后房型睫状沟二期人工晶状体植入41眼(70.69%),缝襻固定后房型人工晶状体17眼(29.31%);术后视力均达到或优于术前矫正视力,最佳矫正视力≥0.3者38眼(65.52%)。术后瞳孔圆者32眼(55.17%),人工晶状体正位者50眼(86.21%),7眼稍偏位,1眼人工晶状体倾斜。结论二期后房型人工晶状体植入术是治疗外伤性无晶状体眼的有效而安全术式,可取得良好效果,术前手术设计和熟练的操作技巧是手术成功的关键。

Objective Traumatic aphakia was a common ailment in ophthalmology. To evaluate the methods and clinical effects of secondary implantion of posterior chamber intraocular lens （IOLs） for traumatic aphakia. Methods Retrospectively ana- lyzed 58 cases（58 eyes） with traumatic aphakia underwent secondary implantion of posterior chamber IOL. About 50 eyes have different anterior segment disorders, such as iris - adhere generally, iridodialysis, pupil deformity and shifting, anterior chamber vitreous hemia, and puoillary zone organize. Secondary intraocular lens im-plantation combined anterior segment reconstruction included： synechotomy, iridodialysis suturation, reposition of iridodialysis, pupil reformation, membranctomy in the pupil erea. 8 eyes utilize delivery tube in vitreous chamber to maintain intraocular tension with traumatic aphakia subjected to lens -vitrectomy surgeries. Results The surgery was successful in all patiens. The patients were followed up from 5 to 24 months. 41 eyes （70.69%） implanted a posterior chamber IOL in ciliary sulcus, 17eyes （29.31%） iOLs fixated with suturing. The postoperative visual acuities in 38 eyes were 〉0.3（65.52% ） , round pupil in 32 eyes, IOL normotopia in 50 eyes, IOL slightly dyssymmetry in 7 eyes, only 1 eye IOL obliquity. Conclusion The therapeutic effect of secondary implantation of posterior chamber IOL for traumatic aphakia, is satisfactory. The key point is skillful manipulation and prepense contrive before operation.