硅油取出术联合四点式后房型人工晶状体巩膜缝线固定术的临床研究

Clinical application of silicone oil removal combined with four-point trans-scleral suture fixation for posteriorchamber intraocular lens implantation

背景玻璃体晶状体切割联合硅油填充术是治疗复杂玻璃体视网膜病变的有效方法。硅油取出术后引起的严重屈光参差常通过Ⅱ期人工晶状体（IOL）植入术进行矫正，不仅增加了手术次数，且手术操作困难，并发症多，效果较差。采用硅油取出联合四点式后房型IOL巩膜缝线固定术可克服上述不足。目的观察硅油取出术联合晶状体及囊膜阙如四点式后房型IOL巩膜缝线固定术的临床应用及效果。方法采用回顾性病例观察研究设计，对晶状体及囊膜阙如的患者20例20眼行硅油取出联合四点式经巩膜缝线悬吊术植入4个襻折叠式IOL，观察术后3d、1周、1个月及3个月的眼前部炎症反应情况，包括眼压、角膜内皮计数、裸眼视力及矫正视力、晶状体位置以及眼底情况，分析术眼的术后并发症及其处理效果。所有患者术前均了解研究目的并签署知情同意书。结果20例患者20眼术后裸眼视力和矫正视力均达到或超过术前矫正视力，其中裸眼视力0．8及以上者2眼，0．6～0．7者6眼，0．3～0．5者8眼，0．05～0．2者4眼。术前裸眼视力明显低于术后裸眼视力，差异有统计学意义（H=10．147，P〈0．01），而术前矫正视力与术后矫正视力差异无统计学意义（H=2．089，P〉0．05）。本组术眼术前平均角膜内皮细胞计数为（2064±329）个／mm^2，术后为（1987＋269）个／mm^2，差异无统计学意义（t=1．660，P〉0．05）。所有术眼IOL位置均未发生明显偏移。本组患者术后未见玻璃体出血及视网膜脱离等严重并发症。结论硅油取出联合四点式后房型IOL巩膜缝线固定术是玻璃体切割术后晶状体及囊膜阙如患者IOL植入的有效方法，安全有效，术后并发症可控，可减少手术次数，患者裸眼视力明显改善。

Background Vitretomy and lenstomy with silicone oil tamponade is an effective method for complicated vitreous retinopathy. The severe anisometropia after silicone retention is usually treated by two-point transscleral suture fixation for posterior chamber intraocular lens （IOL） implantation. In order to reduce the number and difficulty and complication of the operation,the surgical method should be improved. Objective The goal of this study was to observe the result of silicone oil removal combined with four-point trans-scleral suture fixation of posterior chamber IOL after vitrectomy. Methods A retrospective case-observational study design was adopted. Twenty eyes with silicone oil tamponade from 20 patients without lens and posterior capsule after vitrectomy were included in this study. Silicone oil removal with four-point trans-scleral suture fixation of posterior chamber IOL was performed. The anterior ocular inflammatory response, intraocular pressure, uncorrected and corrected aeuities before and after operation, corneal endothelial cell counting and postoperative complications were observed and analyzed. Written informed consent was obtained from all patients prior to the operation. Results All of the operative eyes in this study showed improvement of visual acuity after operation. Of the 20 eyes, a visual acuity of t〉 0. 8 was seen in 2 eyes,0.6-0. 7 in 6 eyes,0.3-0. 5 in 8 eyes and 0.05-0.2 in 4 eyes 3 months after the removal of silicone oil. The uncorrected acuity postoperation was significantly improved in comparison with preoperation （H = 10. 147, P〈0. 01 ） , but no significant difference was found in the corrected acuity between preoperation and postoperation （X^2 = 2. 089,P〈 0.01 ）. The number of the corneal endothelial ceils was （ 2064 ± 329 ） cells/mm： before operation, and that after operation was （ 1987 ± 269 ） cells/ram2 , showing an insignificant change between them （ t = 1. 660, P 〉 0. 05 ）. No abnormality of IOL position was found in all 20 operated eyes. There was not serious postoperative complication in all 20 patients. Conclusions The combination of silicon oil extraction with four-point transscleral suture fixation IOL is effective in eyes without posterior capsule or lens after vitrectomy. It can reduce the operation time and improve the postoperative acuity and the quality of life of patients.