外伤性晶状体全脱位临床资料分析

Clinical analysis on traumatic complete luxated lens

目的探讨外伤性晶状体全脱位的致伤因素、临床特点、手术治疗效果及并发症。方法对25例(25眼)外伤性晶状体全脱位患者的临床资料进行回顾性分析。结果 25例(25眼)患者主要致伤原因是石块或木块崩伤;最常见合并继发性青光眼和外伤性瞳孔散大,同时可合并房角后退,睫状体渗漏(或离断),葡萄膜炎,锯齿缘离断,以及视网膜脱离等。16例行晶状体玻璃体切除联合人工晶状体睫状沟固定术,9例行晶状体玻璃体切除术,未一期植入人工晶状体。术前矫正视力为光感～0.2,眼压8～49 mmHg,平均眼压19.2 mmHg。16例联合人工晶状体睫状沟固定手术患者术后1周矫正视力为光感～0.5,眼压9～23 mmHg,平均眼压15.6 mmHg。人工晶状体位正,无明显倾斜及偏位。9例行晶状体玻璃体切除术术后一周矫正视力为光感～指数,眼压10～19 mmHg,平均眼压13.0 mmHg。结论石块或木块崩伤是外伤性晶状体全脱位的主要致伤原因。常见合并继发性青光眼和外伤性瞳孔散大。晶状体玻璃体切除联合人工晶状体睫状沟固定术是治疗外伤性晶状体全脱位的有效方法。

Objective To explore injury factors,clinical characteristics,effect of surgical treatment,and complications of patients with complete luxated lens.Methods The clinical data of 25 cases（25 eyes） of traumatic complete luxation of lens were retrospectively reviewed and analyzed.Results Among these 25 cases（25 eyes）,13 cases were wounded by stone or wood-fall.The majority of complications were secondary glaucoma and traumatic mydriasis.Other complications included backwards anterior chamber angle,leakage of ciliary body（or disconnection）,uveitis,jagged edge separation,and retinal detachment.16 cases were treated by lens-vitrectomy combined with intraocular lens（IOL） sulcus fixation.Nine cases were treated only by routine lens-vitrectomy without IOL implantation.Preoperative corrected visual acuity（VA） ranged from light perception（LP） to 0.2.The preoperative intraocular pressure（IOP） was 8~49 mm Hg（1 mm Hg=0.133 kPa）,with mean IOP of 19.2 mm Hg.Postoperative corrected visual acuity（VA） of 16 cases with lens implantation ranged from light perception（LP） to 0.5.The postoperative intraocular pressure（IOP） of these 16 cases was 9~23mm Hg with mean IOP of 15.6 mm Hg.All IOL were in normal position without tilting or decentration.Postoperative VA of 9 cases without lens implantation was ranged from light perception to finger count.Postoperative IOP of these 9 cases were 10~19 mm Hg,with mean IOP of 13.0 mm Hg.Conclusion Stone or wood-fall injuries were the leading causes of traumatic dislocation of lens.Majority of complications were secondary glaucoma and traumatic mydriasis.Lens-vitrectomy combined with ciliary sulcus fixation of posterior chamber intraocular lens（PC IOL） is the most effective and safe method for treatment of complete luxated lens caused by ocular trauma.