后房型人工晶状体移位或脱位的相关因素分析及预防处理

Analysis of the relevant factors and preventive treatment of IOL displacement or dislocation

目的:探讨白内障摘除联合后房型人工晶状体植入术后人工晶状体移位或脱位的影响因素、相关预防及处理措施。方法:对2009-02/2010-05因IOL移位或脱位收入我院的病例进行回顾性分析。主要记录原发白内障病情、人工晶状体移位或脱位发现时间、症状及体征、处理方法以及处理前后视力。结果:晶状体移位或脱位患者27例27眼,其中合并其他眼部疾病的并发性白内障17眼。移位或脱位发现时间为术后1d～14a。后囊不同程度破裂12眼;前囊情况:前囊撕裂5眼,撕囊较大3眼,前囊环形撕囊较小囊膜机化收缩混浊1眼;术后有眼部外伤史6眼。27例均通过再次手术得到治疗。术后随访10.23±2.10(3～16)mo。术后裸眼视力优于术前,差异有统计学意义(T=-0.327,P=0.001);最佳矫正视力术后与术前相比差异无统计学意义(T=-0.611,P=0.541)。结论:眼部病情复杂、后囊破裂、前囊撕囊欠佳、术后眼部外伤是影响人工晶状体移位或脱位的重要因素。熟练的手术技术和正确处理术中并发症是预防人工晶状体移位或脱位的关键。人工晶状体调位术或人工晶状体悬吊术是处理人工晶状体移位或脱位的有效方法。

AIM：To investigate related factors,prevention and treatment measures of intraocular lens（IOL）displacement or dislocation in cataract extraction and posterior chamber IOL implantation.METHODS：IOL displacement or dislocation enrolled into our hospital from February 2009 to May 2010 were retrospectively analyzed.The main record included the cataract condition,discovery time of displacement or dislocation of IOL,the symptoms and signs,treatment and visual acuity before and after treatment.RESULTS：Displacement or dislocation of lens was recorded in 27 patients with 27 eyes,among which 17 eyes were combined with other ocular diseases complicated cataract.Discovery time of displacement or dislocation was postoperative 1 day-14 years.Varying degrees of posterior capsule rupture was recorded in 12 eyes;anterior capsule tear in 5 eyes,a larger capsulorhexis in 3 eyes,small circular capsulorhexis with organized contraction and opacification of anterior capsule in 1 eye;postoperative history of ocular trauma in 6 eyes.27 patients were treated by reoperation and followed up for 10.23±2.10（3-16）months.Uncorrected visual acuity was better than that of before surgery,the difference was statistically significant（T=-0.327,P=0.001）;compared with before surgery,best-corrected visual acuity after surgery was of no significant difference（T=-0.611,P=0.541）.CONCLUSION：The complexity of the eye disease,posterior capsule rupture,poor anterior capsule capsulorhexis,postoperative ocular trauma are the important impact factors of displacement or dislocation of IOL.Skilled surgical technique,proper treatment of intraoperative complications are key to prevent displacement or dislocation of IOL.IOL position adjusting or suspension surgery is an effective way to deal with displaced or dislocated IOL.