白内障术中虹膜松弛综合症的临床分析

Clinical analysis of intraoperative floppy-iris syndrome in cataract surgery

目的:探讨虹膜松弛综合症(intraoperative floppy-iris syndrome,IFIS)在白内障术中发生的原因、临床表现及临床措施。方法:总结性回顾我院2008-01/2009-12施行白内障手术患者489例558眼,对手术患者术前询问全身病史和用药史,2009年对特定患者进行术前预防性局部10g/L硫酸阿托品点眼。白内障术中发生IFIS11眼,术中对出现IFIS者使用前房注射稀释盐酸肾上腺素、黏弹剂,部分使用虹膜拉钩、虹膜扩张环等,观察虹膜及瞳孔的变化。结果:2008年发病9例,2009年发病2例,2aIFIS发生率差异有临床意义(P<0.05)。结论:白内障术中IFIS的发生与术前使用α1-肾上腺素能受体阻滞剂有关,术前对相关病例使用预防性措施能降低发病率。对出现IFIS患者术中使用前房注射稀释盐酸肾上腺素、黏弹剂,术中使用虹膜拉钩、虹膜扩张环等,能基本阻止虹膜向切口脱出的倾向,瞳孔缩小有一定改善,有效减少手术并发症。

AIM：To discuss the pathogen, clinical manifestation and the treatment of the intraoperative floppy-iris syndrome（IFIS）which occurs in the process of cataract surgery.METHODS： Totally 489 operation inpatients （558 eyes） with extracapsular cataract extraction （ECCE） and phacoemulsification in our hospital in 2008-2009 were reviewed. We analyzed the holistic and local drug-use state of patients preoperatively and surveyed the changes in the iris and the pupil of these operation on inpatients of IFIS when we injected adrenalin hydrochloride and viscoat in anterior chamber or used iris hooks and iris dilator rings in operations.RESULTS： In 2008, 9 cases attacked by IFIS in 236 operation inpatients of cataract surgery （279 eyes）, and in 2009, 2 cases in 2009 in 253 operation inpatients of cataract surgery （279 eyes）. The incidence rate difference（IRD） of IFIS in two years had clinical significance （P〈0.05）.CONCLUSION： The incidence of IFIS in cataract surgery is related to the using of α1 antitrypsin deficiency. Taking preventive action can reduce the morbidity for related cases before the operation. In operations, for the case of prolapse of iris and the contraction of pupil, injecting diluted adrenalin hydrochloride and viscoat in anterior chamber or using iris hooks and iris dilator rings when performed can prevent the tendency of prolapse of the iris through the incision basically, ameliorate the level of the contraction of pupil to a certain extent and reduce the incidence of the complication