合并虹膜缺损的人工晶状体植入手术方法

Intraocular lens implantation for patients with coloboma of the iris

目的探讨合并有虹膜缺损眼的人工晶状体（IOL）植人手术方法。方法回顾性系列病例研究。虹膜缺损患者56例（63眼），分析虹膜缺损及晶状体特征，对于虹膜缺损范围较小、晶状体囊袋完整的患者，采用虹膜缝合联合后房囊袋内IOL植入术：对于虹膜缺损范围小于一个象限、虹膜萎缩严重、晶状体囊袋缺损严重者行瞳孔缘环形缝合合并前房IOL植入术：对于虹膜缺损范围大而囊袋完整的患者，采用人工虹膜合并IOL囊袋植入术；对于虹膜和囊袋均大范围缺损者，采用带虹膜的IOL植入术。术后随访5个月～5年，观察术后裸眼视力、畏光情况、IOL位置、术后并发症及处理方法。结果除弱视和严重角膜瘢痕患者外术后裸眼视力均有不同程度提高。接受虹膜缝合联合白内障摘除加囊袋内IOL植入术的11例患者，其中术后视力〈0．1者3例，O．1-0．4者5例，0．5-0．8者2例，〉0．8者1例。其中3例先天性患者均因弱视视力提高不明显。接受瞳孔缘环形缝合合并前房IOL植入术的6例外伤患者，术后视力0．1～0．4者4例，0．6者2例。接受人工虹膜合并IOL囊袋内植入术的患者，其中4例先天性白内障患者因弱视形成矫正视力〈0．1；另8例0．1～0．4者2例，0．5～0．8者5例，〉0．8者1例。接受带虹膜的IOL植入术的27例患者中，术后视力数指～0．1者5例，0．1～O．4者14例，0．5～O．8者8例。畏光现象明显改善，患者满意度及舒适度理想。早期并发症包括前房出血、眼压升高、葡萄膜炎等，随访中未见角膜失代偿、IOL脱位等严重并发症。结论根据虹膜缺损情况和囊袋完整程度选择不同方式的IOL植入术，能有效提高患者视力，并改善畏光等视觉症状。

Objective To investigate the clinical therapeutic effects of intraocular lens implantation for patients with coloboma of the iris. Methods Fifty-six patients （63 eyes） with iris defects were reviewed. For patients with a small range of iris defects and intact capsular bag, the iris can be sutured and an intracapsular lens can be implanted; for patients with serious damage to the iris and capsular bag defect, the iris can be sutured and an anterior chamber lens can be implanted; for patients with extensive iris defect and intact capsular bag, an artificial iris combined with an intraocular lens can be implanted in the capsular bag; for patients with a wide range of iris and capsular bag defects, an intraocular lens combined with an iris can be implanted. Patients were followed up from 5 months to 5 years to monitor visual acuity, sensitivity to light, intraocular lens position and postoperative complications and treatment. Results Except amblyopia and severe corneal scarring, most patients visual acuity improved. Eleven patients accepted the surgery of iris sutured and an intracapsular lens implanted, 〈0.1 in 2 cases, 0.1-0.4 in 5 cases, 0.5-0.8 in 2 cases, 〉0.8 in 1 case, the other 3 cases of patients was unchanged due to congenital amblyopia. Six patients accepted the surgery of iris sutured and an anterior chamber lens implanted, visual acuity improved to 0.1-0.4 in 4 cases, 0.6 in 2 case. Twelve patients accepted the surgery of an intraocular lens combined with an iris implanted, among them, 4 cases with congenital cataract was unchanged due to amblyopia, visual acuity improved to 0.1--0.4 in 2 cases, 0.5-0.8 in 5 cases, 〉0.8 in 1 case of theother 8 cases. Twenty-seven patients accepted the surgery of an intraocular lens combined with an iris implanted, count finger-0.1 in 5 cases, 0.1-0.4 in 14 cases, 0.5-0.8 in 8 cases. No photophobia phenomenon was observed. Patient satisfaction and comfort were good. Early complications included hyphema, high intraocular pressure, and uveitis. Corneal decompensation, intraocular lens dislocation or other serious complications were not observed. Conclusion Different techniques for intraocular lens implantation can improve visual acuity and photophobia depending on the condition of the iris and capsular bag.