Artisan人工晶状体植入矫正玻璃体切除术后无晶状体眼的临床观察

Secondary Artisan intraocular lens implantation for aphakia correction in eyes after vitrectomy and lensectomy

目的观察晶状体玻璃体切除术后眼内二期植入Artisan晶状体的有效性、可预测性和安全性。方法回顾性分析16例因各种眼外伤行晶状体、玻璃体切除术后二期植入Artisan晶状体的病人。观察指标包括：手术时间，术前及术后的裸眼及矫正视力，屈光度，角膜内皮细胞计数，术中术后并发症。随访时间（26．3±3．6）个月。结果平均眼轴（22．46±0．47）mm，手术经历时间15～36min，平均（17．3±4．4）min。术中有12例病人人工晶状体近水平放置，4例病人斜向放置。所有病人术后裸眼视力均较术前提高，术后6个月，裸眼视力等于术前最佳矫正视力的有6例，0．3及以上者13例，0．2者2例，0．1者1例。手术预留屈光度为轻度近视（-0．5D），术前与术后6个月屈光度对比，球镜屈光度：术前（＋10．2±1．09）D，术后：（-0．63±0．44）D（P〈0．05）；柱镜屈光度（绝对值），术前：（1．84±1．56）D，术后：（1．97±1．69）D（P〉0．05）。4例斜向放置病人术后平均球镜屈光度为一0．75D。柱镜屈光度（绝对值），术前1．94D，术后1．75D。术前角膜内皮细胞计数（2377．4±279．74）个／mm2，术后1年角膜内皮细胞计数均数为（2265．7±258．65）个／mm2，损失率为4．7％；术后2年平均为（2244．4±249．32）个／mm2，第2年损失率为0．94％。并发症：2例病人少量前房出血，3例病人一过性角膜水肿，3例病人术后低眼压（〈8mmHg），其中1例病人伴视物晃动感，上述并发症均于1周内恢复。未观察到其它并发症。结论晶状体玻璃体切除术后二期植入Artisan晶状体有效性、预测性良好，2年随访有较好安全性。

Objective To evaluate efficacy, predictability and safety of Artisan intraocular lens （IOL） secondary implantation for aphakic correction in eyes after vitrectomy and lensectomy. Meth- ods Retrospectively study 16 patients underwent Ai＇tisan IOL secondary implantation for aphakic cor- rection in eyes after vitrectomy and lensectomy due to eye trauma. Operation time, uncorrected visu- al acuity, best corrected visual acuity （BCVA）, refraction, endothelial cell count, and clinical compli- cations were evaluated. All the patients were followed up to 26.3±3.6 months. Results The mean axial length was 22.46±0.47mm. The mean operation time was 17.3±4.4 minutes, ranged from 15 minutes to 36 minutes. The IOL was implanted horizontally in 12 patients and implanted obliquely in 4 patients. Postoperative uncorrected visual acuity improved in all the patients, uncorrected visual acuity equal to preoperative BCVA in 6 patients, better or equal to 0.3 in 13 patients. Mean spheri- cal degree was ＋10.2±1.09 diopter （D） preoperative and-0.63±0.44D postoperative （P 〈0.05）. Mean degree of astigmatism was 1.84±1.56D preoperative and 1.97±1.69D postoperative （P 〉0.05）. For the 4 patients IOL implanted obliquely, the mean spherical degree was -0.75D postoperative and the de-gree of astigmatism was 1.94D preoperative and 1.75D postoperative. Preoperative mean endothelial cell count was 2377.4±279.74 cells/mm2, mean endothelial cell loss was 4.7% 12 months postopera- tively and 0.94% during the second year. Complications included hyphema in 2 patients, transient cornea edema in 3 patients and hypotonY in 3 patients, one of which had hypotony combined with visual tremor. All the complications recovered in one week .No other complications were observed. Conclusions Artisan IOL implantation seems a predictable and effective option for eyes after vitrec- tomy and lensectomy without capsule support, and it is safe during 2 years follow up.