Akreos Adapt人工晶状体十字形袋／沟固定法在后囊大破孔时的应用

Akreos adaptable foldable intraocular lens implantation with crossed bag/sulcus when there is a large rupture in the posterior capsule

目的 观察Akreos Adapt亲水性丙烯酸酯折叠式人工晶状体（IOL）十字形袋/沟固定法植入在外伤后或白内障术中出现的后囊大破孔时应用的临床效果.方法 对31例（31眼）后囊大破孔者采用十字形袋/沟固定法植入Akreos Adapt亲水性丙烯酸酯折叠式IOL.随访期内观察其术后视力及视觉症状、术后炎症反应、IOL位置及固定状态、囊膜混浊程度、瞳孔和眼压等情况.结果 术后所有眼视力均较术前提高,最佳矫正视力0.1～0.2者4眼,0.3～0.4者5眼,≥0.5者22眼.所有术眼的IOL均在位,基本居中、无移位,视轴透明,未见严重的术后炎症反应或IOL相关并发症,瞳孔及眼压正常.结论 在后囊大破孔但连续环形撕囊完整时可采用十字形袋/沟固定法植入Akreos Adapt亲水性丙烯酸酯折叠式IOL,该法简便、快捷、安全,植入后IOL位置稳定居中,并有良好的生物相容性和眼内稳定性.

Objective To observe the clinical results of Akreos adaptable foldable intraocular lens （IOL） implantation when the posterior capsule has a large rupture. Methods Thirty-one cataract cases （31 eyes） with a large rupture in the posterior capsule underwent Akreos adaptable foldable IOL implantation with crossed bag/sulcus fixation. Of these, 9 had traumatic cataracts and 22 had age-related cataracts. A continuous curvilinear capsulorhexis （CCC） technique was used and the diameters were about 5.0-5.5 mm. When the posterior capsule rupture was found during the operation, after the cortex or vitreous loss was cleanly managed with a vitreous cutter, the IOL was first implanted into the anterior chamber, the two haptics from the opposite angles were then pressed into the capsular bag. The remaining haptics were left on the surface of the anterior capsule. Thus,the IOL was implanted with crossed bag/sulcus fixation. Visual acuity, visual symptoms, the position and fixation of the IOL, inflammatory reaction and posterior capsule opacity were assessed postoperatively. All cases were followed up for at least 3 months. Results The visual acuity of all surgical eyes was improved after the operation. The best corrected visual acuity was 0.1-0.2 in 4eyes, 0.3-0.4 in 5 eyes, and ≥0.5 in 22 eyes. The implanted IOL remained centered and stable in all surgical eyes and no displacement was observed. The optics of the IOL and the posterior capsule holes were clear without fibroplasias. The pupils were centered and no posterior synechia, severe inflammation, IOL-related complications or glare occurred. Conclusion While a posterior capsule with a large rupture appeared, good CCC is still possible during the operation. The use of crossed bag/sulcus fixation to implant the Akreos adaptable foldable IOL is easy and safe. The IOL position is centered and no displacement occurred after the implantation. The results show good biocompatibility and stability with low postoperative inflammation and low posterior capsule opacity （PCO） due to its sharp edge.