两种软性材质可折叠IOL在剥脱综合征性白内障患者中临床应用

Application of intraocular lens from two kinds of soft foldable materials for cataract with exfoliation syndrome

目的:研讨剥脱综合征性白内障植入Acrysof Natural和硅胶人工晶状体的效果。方法:选择无青光眼发作史的剥脱综合征性白内障65例70眼行超声乳化吸出白内障,无术中并发症60例63眼。其中30例33眼用植入器植入Acrysof Natural人工晶状体;另30例30眼用植入器植入硅胶(silicone)人工晶状体。统计植入术中并发症;术后1d,1wk,3mo,1a的视力、眼压、前房情况、人工晶状体稳定性。结果:Acrysof Natural在植入过程中展开慢,可控性好,在剥脱综合征患者瞳孔不易散大情况下仍能顺利植入,无并发症。对照组硅胶人工晶状体展开时弹射快,有7眼植入过程中发生翻转,在部分悬韧带不健全的病例同时因瞳孔缩小不易观察和控制,造成5眼植入时袢划破后囊膜(16.6%)。1枚弹入玻璃体,取出后改睫状沟植入。术后视力对后囊破裂者不列入正常统计。结论:选择Acrysof Natural人工晶状体单体、袢宽软、植入过程中展开慢、好控制、可避免植入过程并发症。其光学部分相对薄、稳定性好、前房相对较深。组织相容性好,术后反应轻。

AIM：To compare the effects of Acrysof Natural intraocular lens（IOL）implantation and silicone IOL implantation,for cataract with exfoliation syndrome（EFS）.METHODS：Totally 65 EFS cataract patients（70 eyes） who had no glaucoma history were selected,and phacoemulsification was performed in the patients.60 cases 63 eyes had no complications during operation.30 cases 33 eyes were implanted Acrysof Natural IOL,the another,30 cases 30 eyes,were implanted silicone IOL with implantation apparatus.The complications,visual acuity,intraocular pressure（IOP）,anterior chamber,the stability of IOL were statistically analyzed at 1 day,1 week,3 months,1 year after operation.RESULTS：Acrysof Natural with slow progresion in implantation and good controllablility could still be properly implanted even if the EFS patients＇ pupils were not easily dilated,and without any other complication.In contrast,silicone spread quickly rotated during operation in 7 eyes,Posterior capsule rupture happened in 5 eyes（16.6%） during implantation because the observation and control became more difficult due to pupil dwindled in some defected zonule cases（7 eyes）.One silicone IOL sprung into vitreous body.The implantion through ciliary sulcus after taking it out from vitreous body was chose.The postoperative visual acuity of posterior capsule rupture was not calculated in the statistics.CONCLUSION：IOL implantation surgery for cataract patients with EFS has high risks because it is not so easy to dilate their pupils and their ciliary zonule is brittle.Some complications occur in surgery,such as posterior capsule rupture,ciliary zonule break,vitreous body prolapsus and IOL dislocation.The softer Acrysof Natural IOL with slow progression,good controll ability in operation and few complication is applied widely.It also has some other advantages,such as relatively thin optical parts,better stability,relatively deeper anterior chamber,more compatible with organisms,slighter postoperative reaction.