25G灌注下二期缝合植入折叠型人工晶状体治疗玻璃体切割术后无晶状体眼

Sutured intraocular lens placement in aphakic post-vitrectomy eyes via 3mm incision surgery and 25G irrigation

目的评价25G灌注下经3mm切口二期缝线固定植入注入式折叠型人工晶状体治疗玻璃切割（简称玻切）术后无晶状体眼的临床疗效。方法29例（29只眼）玻璃体切割术后无晶状体眼患者，男22例（22只眼），女7例（7只眼），年龄19—52岁，平均35．2岁。术前裸眼视力指数／眼前。0．08，最佳矫正视力0.3～1．0，屈光度球镜＋8．50-＋13．0DS，柱镜-0．75—-2．50DC。均在25G灌注下行Akreos注入式折叠型人工晶状体经3mm切口缝合固定二期植入术，人工晶状体度数选择除4例因对侧眼为近视眼保留了相应度数外，余按正视眼矫正。术后观察裸眼视力、最佳矫正视力、眼压、屈光度、人工晶状体位置和并发症发生情况。结果术后3—6月术后裸眼视力0．2～0．5，较术前有明显提高（P〈0．05）；最佳矫正视力0．3～0．8，与术前比较差异无统计学意义（P〉0．05）；与预期屈光度相比，除1例年轻患者因对侧眼戴镜-6．0DS，术眼保留了-5．0DS的球镜外，其余患者术后验光球镜度数为＋0．50—0．75DS，柱镜度数为-0．5--2．25DC平均-1．75DC。术后随访6～24个月，经散瞳后裂隙灯显微镜和UBM检查，25例（25只眼）人工晶状体位置居中，轻度偏中心3只眼，轻度倾斜1只眼，无一例有不适主诉。术后并发症：低眼压5例，3～5d后全部恢复；有玻璃体少量积血1例，5d后基本吸收；所有病例未出现角膜水肿、无严重玻璃体积血、无视网膜脱离、无继发性青光眼等并发症。结论在微创25G眼内灌注保护下，经3mm切口缝合植入注入式折叠型人工晶状体治疗玻切术后无晶状体眼，避免了以往大切口二期植入人工晶状体眼术中眼压波动、易出血、术后切口愈合慢、散光大的缺点，具有操作简单，安全有效、创伤小、术后恢复快等优点，为患者提供了较好的术后裸眼视力，大大提高了患者的视觉质量。

Objective To evaluate the therapeutic efficacy of sutured intraocular lens placement in aphakic post-vitrectomy eyes via 3mm incision surgery and 25 G irrigation. Methods Twenty-nine patients （29 eyes） were aphakic post-vitrectomy eyes, including 22 males and 7 females. Before the operation, the uncorrected distance visual acuity was from counting fingers to 0.08, and the best corrected visual acuity was from 0.3 to 1.0 with ＋8.50～＋13.50 DS and -0.75 ～ -2.50 DC. All cases were performed the surgery which a Akreos foldable IOL was used to facilitate 2-point fixation through a 3mm incision with 25 G irrigating. Post-operation uncorrected VA, best corrected VA, lOP, diopter, IOL location and complication were observed. Results Followed-up 3 - 6 months post-operation, uncorrected VA was from 0.2 - 0.5, better than pre-operation and best corrected VA was similar to pre-operation with ＋0.50 - -0.75 DS and -0.5～-2.25 DC. Twenty-five IOLs were good centration, 3 IOLs with gently dislocation, 1 IOL with gently tilt and no one with the uncomfortable complains. Five cases with low IOP recover normal IOP after 3 - 5 days. No cases showed up corneal edema, retinal detachment and glaucoma. Conclusions With 25 G irrigating, sutured intraocular lens placement in aphakic post-vitrectomy eyes via 3ram incision surgery is a safe, efficient and simple surgery with small wound and quick recovery. It provides the patients with good uncorrected visual acuity post-operation and highly elevates the vision quality.