玻璃体切除联合内窥镜引导人工晶状体固定在眼外伤治疗中的应用

Combined vitrectomy and endoscopy-guided posterior chamber intraocular lens transscleral fixation in ocular trauma

目的探讨玻璃体切除（PPV）联合内窥镜引导人工晶状体（IOL）固定术对伴有晶状体位置异常的外伤性玻璃体积血的治疗效果。方法11例（11眼）行PPV联合内窥镜辅助IOL固定术。9例采用折叠式IOL缝线固定于睫状沟，2例伴有虹膜大部脱失者采取带虹膜隔IOL缝线固定于前平坦部。对照组选取我院常规方法处理的白内障术中后囊破裂坠核的3例。观察指标包括：术后视力、前房炎症反应、眼压及超声生物显微镜检查（UBM）等。结果随访1～9个月，裸眼视力〉0．5者7眼，0．2～0．4者3眼，0．1者1眼。UBM显示，对照组1例IOL一侧襻位置靠后接近睫状体平坦部导致体部偏位，而内窥镜辅助手术IOL全部位置准确；裂隙灯显微镜检查所有IOL位置正常。影响术后视力恢复主要由于不规则角膜散光、黄斑水肿和视神经挫伤。结论PPV联合内窥镜下IOL固定术是治疗严重眼外伤伴晶状体位置异常的安全有效的方法。

Objective To determine the effect of combined pars plana vitrectomy （PPV） and transscleral intraocnlar lens （IOL） fixation under endoscope guidance in the management of traumatic vitre- ous hemorrhage with dislocation of the lens or IOL. Methods Endoscope-assisted PPV and transscleral IOL fixation were performed in 11 eyes of 11 patients. The foldable IOLs were fixed in ciliary sulcus in nine ca- ses, and an aniridia IOL was fixed in anterior pars plana in the other two cases with iris loss. 3 patients with dropped nucleus in phacoemulsification process who sustained regular treatment were taken as control. Ob- served items included post-surgery vision, anterior chamber inflammation, intraocnlar pressure, ultrasound biomicroscope（UBM） examination. Results Follow-up ranged from 1 month to 9 months （4. 1 ± 2.3 ） months. Postoperatively, uncon＇ected visual acuities were 0.5 or better in 7 cases, 0.2-0.4 in 3 cases, 0.1 in one case. UBM results indicated that all IOL position fixed under endoscope-guidance were correct, whereas one side loop of one case approached to anterior pars plana in control. The main factors influencing visual rehabilitation were irregular corneal astigmatism, macular edema and optic nerve contusion. Conclu- sion Combined PPV and endoscopy-induced transscleral IOL fixation is effective and safe in dealing with severe eye trauma.