人工晶状体置换术治疗人工晶状体眼屈光意外

Refractive deviation in intraocular lens exchange for pseudophakic eye

目的探讨人工晶状体眼屈光意外出现的原因、人工晶状体置换术手术原则和治疗效果。方法回顾性分析行人工晶状体置换术患者10例(10眼)的临床资料。分析人工晶状体眼屈光意外的原因,总结手术方法 ,并观察手术疗效。结果人工晶状体眼屈光意外的原因为眼轴测量误差3眼,术前未作测量2眼,A常数错误2眼,角膜曲率测量误差1眼,使用不合适的人工晶状体计算公式1眼,植入错误的人工晶状体1眼。眼轴长度<23mm者3眼,眼轴长度23～24mm者3眼,眼轴长度>24mm者4眼。手术置换人工晶状体的方法包括晶状体囊袋内植入8眼,睫状沟植入2眼。术后裸眼视力在0.5以上者9眼,裸眼视力在0.8以上者7眼,最佳矫正视力在0.5以上者10眼。手术的主要并发症为后囊膜破裂2眼和后囊膜混浊1眼。结论人工晶状体眼屈光意外的原因较多,眼轴测量误差是主要原因之一;眼轴过长、过短者较易出现人工晶状体植入术后屈光意外;正确选择人工晶状体可减少人工晶状体眼屈光意外发生;人工晶状体置换术是处理人工晶状体眼屈光意外的有效方法 。

Objective To discuss the reasons of refractive deviation,surgical principle and effect of intraocular lens（IOL）exchange for pseudophakic eye.Methods Ten eyes underwent IOL exchanges were reviewed retrospectively.Reasons for refractive deviation were analyzed,the surgical methods were summarized and the surgical effects were observed.Incorrect lens power,axial length（AL）,uncorrected visual acuity（UCVA）,best spectacle-corrected visual acuity（BSCVA）,and complications were evaluated.Results Of the 10 cases（10 eyes）,the identified reasons of refractive deviation were incorrect axial length（AL）determination in 3 eyes,no measurement before operation in 2 eyes,wrong A-constant in 2 eyes,keratometry errors in 1 eye,calculated with inadequate IOL calculation formula in 1 eye,and insertion of a wrong IOL in 1 eye.There were 3 eyes with AL less than 23 mm,3 eyes with AL from 23 mm to 24 mm and 4 eyes with AL more than 24 mm.IOL was inserted in the lens bag in 8 eyes and in the ciliary sulcus in 2 eyes.After IOL exchange,the uncorrected visual acuity were 0.5 or better in 9 eyes,0.8 or better in 7 eyes,and the best spectacle-corrected visual acuity were 0.5 or better in all of eyes.The surgical complications included posterior capsular rupture in 2 eyes and posterior capsular opacification in 1 eye.Conclusions Among the identified causes,error in AL measurement is one of the most frequent reasons for incorrect IOL power implantation.Refractive deviation occurs more frequently in eyes with AL abnormal than in normal ones.Proper IOL selection can avoid unexpected postoperative refractive deviation,and IOL exchange is an effective way to manage the situation.