瞳孔成形联合虹膜夹型人工晶状体植入术临床观察

Iris-claw intraocular lens implantation after pupil reconstruction in 8 patients with iris rupture

目的观察瞳孔成形联合虹膜夹型人工晶状体植入术在外伤性白内障伴有虹膜损伤患眼中的疗效。方法回顾性分析2010年5月至2011年8月在温州医学院附属眼视光医院眼外伤专科采用瞳孔成形联合虹膜夹型人丁晶状体植入术治疗外伤性白内障伴有虹膜损伤患者，共8例8只眼。眼球钝挫伤3例，穿通伤5例，术前均确诊为外伤性白内障，其中3例伴有品状体脱位。术后随访4—11个月，观察术后视力、角膜内皮细胞计数、瞳孔情况及人丁晶状体位置、眼压等。结果8例均成功修补损伤虹膜，顺利植入虹膜夹型人工晶状体。术后视力均达到或超过术前预测视力，术后矫正视力≥0．6共6只眼，占75％。瞳孔正常生理功能基本恢复，无明显畏光、眩光、复视等不适症状。虹膜夹型人工晶状体无明显偏位，无眼压升高、角膜内皮失代偿等情况。结论瞳孔成形联合虹膜夹型人工晶状体植入术是治疗无囊膜支持的无晶状体眼合并虹膜损伤的相对安全、有效的方法之一。

Objective To observe the anatomic and functional recovery of Iris-claw intraocular lens （IOL） implantation after iris and pupil reconstruction in traumatic cataract eyes with ruptured iris or dilated pupil. Methods This retrospective case series included 8 eyes of 8 patients with iris and pupil reconstruction combined with iris-claw IOL implantation from May 2010 to August 2011 in the Affiliated Eye Hospital of Wenzhou Medical College. Three were eye blunt injury, 5 were penetrating ocular trauma. All patients were diagnosed traumatic cataract, including 3 patients with lens dislocation. Primary outcome measurements included visual acuity, central endothelium cell count, pupil situation, position of IOL, intraocular pressure, etc. Results 1OL were implanted and their irises/pupils were repaired successfully. With 4-11 months following up, visual acuity in all of 8 cases was better or equal to the preoperative predictable vision. There were 6 eyes （75%） with the best visual acuity no less than 0.6. Photophobia, dazzling sensation and other symptoms disap- peared. No complications of iris-claw IOL dislocation, high intraocular pressure, or corneal decompen- sation happened in the 8 cases. Conclusions Iris and pupil reconstruction combined with iris-claw IOL implantation is a safe and efficacious option for traumatic cataract eyes with absence of capsule support and ruptured iris or dilated pupil.