两种硅油取出联合人工晶状体Ⅱ期植入术疗效比较

Comparison of therapeutic effects between two kinds of silicon oil removal combined with secondary posterior chamber intraocular lens implantation

目的:比较经睫状体平坦部三切口硅油取出联合人工晶状体囊袋内或睫状沟植入术与既往二切口硅油取出联合人工晶状体睫状沟缝合术治疗玻璃体切割术后硅油填充无晶状体眼的疗效及并发症。方法:回顾性分析2004-01/2006-12及2007-01/2009-12于中国医科大学附属第一医院眼科分别行上述两种硅油取出联合人工晶状体Ⅱ期植入术共计698例713眼,其中二切口组305例314眼,三切口组393例399眼,比较两组视力提高、术中及围手术期并发症、术后1a内玻璃体再出血、视网膜脱离复发、视网膜前膜发生率。结果:二切口组术后视力提高2行及以上98眼(31.2%),术后发生角膜内皮失代偿6眼(1.9%),术后发生低眼压13眼(4.1%),高眼压者11眼(3.5%),人工晶状体严重偏位者17眼(5.4%),术后1a内玻璃体再出血37眼(11.8%),视网膜脱离复发24眼(7.6%),视网膜前膜者45眼(14.3%);三切口组术后视力提高2行及以上者217眼(54.4%),术后角膜内皮失代偿及术后高眼压者均为0,术后低眼压5眼(1.3%),人工晶状体严重偏位者6眼(1.6%),术后1a内玻璃体再出血9眼(2.3%),视网膜脱离复发7眼(1.8%),视网膜前膜者3眼(0.8%),两组比较有统计学意义(P<0.05)。结论:与既往二切口硅油取出联合人工晶状体睫状沟缝合术比较,经睫状体平坦部三切口硅油取出联合人工晶状体囊袋内或睫状沟植入术疗效更好,并发症少,适宜广泛应用。

AIM：To compare the therapeutic effects and complications in the silicon-oil-tamponaded eyes without lens between silicon oil removal with three incisions through pars plana corporis ciliaris combined with secondary posterior chamber intraocular lens（IOL） implantation into capsular bag or ciliary sulcus and silicon oil removal with two incisions combined with secondary posterior chamber IOL implantation by suturing IOL in ciliary sulcus retrospectively·METHODS： Totally 698 cases（713 eyes） from January 2004 to December 2006 and January 2007 to December 2009 in the First Hospital of China Medical University were analyzed retrospectively,they were treated by above-mentioned two kinds of silicon oil removal combined with secondary posterior chamber IOL implantation respectively.Among them,the group of two incisions was 305 cases（314 eyes）,the group of three incisions was 393 cases（399 eyes）,and the raise of best-corrected visual acuity and the incidence rate of intraoperative and perioperative complication,vitreous rehaemorrhagia,retina redetachment and preretinal membrane were compared·RESULTS：In the group of two incisions,best-corrected visual acuity improved above two lines occurred in 98 eyes（31.2%）,corneal endothelium decompensation in 6 eyes（1.9%）,intraocular hypotension in 13 eyes（4.1%）,intraocular hypertension 11 eyes（3.5%）,IOL dyssymmetry seriously in 17 eyes（5.4%）,vitreous rehaemorrhagia in 37 eyes（11.8%）,retina redetachment 24 eyes（7.6%）,preretinal membrane 1 year after operation 45 eyes（14.3%）;in the group of three incisions,best-corrected visual acuity improved above two lines occurred in 217 eyes（54.4%）,the number of corneal endothelium decompensation and intraocular hypertension was 0,intraocular hypotension in 5 eyes（1.3%）,IOL dyssymmetry seriously in 6 eyes（1.6%）,vitreous rehaemorrhagia in 9 eyes（2.3%）,retina redetachment 7 eyes（1.8%）,preretinal membrane 1 year after operation 3 eyes（0.8%）,those were significantly different between the two groups·CONCLUSION：Compared with the group of silicon oil removal with two incisions combined with secondary posterior chamber IOL implantation by suturing IOL in ciliary sulcus retrospectively,the group of silicon oil removal with three incisions through pars plana corporis ciliaris combined with secondary posterior chamber IOL implantation into capsular bag or ciliary sulcus have better therapeutic effect,a lower incidence of postoperative complications is suitable for wide application.