虹膜松弛综合征的临床分析

Clinical analysis of intraoperative floppy iris syndrome

目的探讨虹膜松驰综合征(IFIS)的发生与使用α1肾上腺素能受体阻滞剂的关系。方法回顾性分析白内障手术患者570例(602只眼)的临床资料。其中服用α1肾上腺素能受体阻滞剂的患者48例(54只眼),施行白内障超声乳化(PHACO)及白内障囊外摘除术(ECCE)各301只眼,分析IFIS的发生率与手术方式及服用α1肾上腺素能受体阻滞剂时间长短之间的关系。结果在48例(54只眼)服用α1肾上腺素能受体阻滞剂患者中,19例(20只眼)发生了IFIS,占白内障手术总人数的3.32%。ECCE组与PHACO组IFIS发生率比较,χ2=5.17,差异有显著性。口服α1肾上腺素能受体阻滞剂的时间长短与IFIS的发生无显著差异。结论服用α1肾上腺素能受体阻滞剂的患者是IFIS的高危人群,该类患者术前最好用阿托品扩瞳,术中前房内注射肾上腺素或苯肾上腺素,对瞳孔无法扩大者,术中可用虹膜拉钩,虹膜扩张器等辅助器械,以减少术中、术后并发症的发生。

Objective To investigate the rehtiouship of the intraopemtive floppy-iris syndrome （ IFIS ） which oceurs in the process of cataract surgery and application of α1 adrenergic antagonist. Methods 570 eases （ 602 eyes ） with cata- ract were a retrospective study. Among the patients,ECCE and PHACO is to half（ 301 eyes）. To discuss if the incidence of IFIS in cataract surgery is related to the method of cataract surgery and the time of patients using α1 antagonist. Results 20 eases attacked by IFIS among the 48 eases（54eyes ）use α1 adronergic antagonist, which is 3.32% among all theOph- thalmolngy, Ruijin hospital luwan branch operation inpatients. The incidence/ate difference of IFIS in ECCE is higher than PHACO,x2 =5.17,had clinical sigaificance. The incidence rate difference of IFIS in how long the patients using α1 antag- onist had no clinical significance. Conclusion The patients who using al antagonist are the high risk group in IFIS. Be- fore operation, using atropine to dilate the pupils,in operations,injecting diluted adrenalin hydrochloride and phenylephilne 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.