折叠人工晶状体无缝线固定悬挂术临床效果观察

Clinical effect observation of the sutureless suspension technique for foldable intraocular lens implantations

目的:观察后房型三体折叠式丙烯酸非球面人工晶状体经透明角膜切口植入并巩膜隧道无缝线固定悬挂术后的临床效果。方法:观察后房型三体折叠式非球面人工晶状体经透明角膜切口植入并巩膜隧道无缝线固定悬挂术的临床效果。对视力、超声生物显微镜(UBM)显示的晶状体位置、眼内反应等参数进行术前术后对比。结果:随访3～12(平均6.5)mo,术后矫正视力:1.0～1.5者8眼(33.3%),0.5～0.9者13眼(54.2%),0.1～0.4者3眼(12.5%),手术后裸眼及矫正视力较术前均有显著性提高(P<0.01)。UBM显示人工晶状体体部平面与角膜内皮间距,和睫状突平面与角膜内皮间距之间差异无统计学意义(P>0.05),与囊袋内植入人工晶状体者位置相似,术后未出现明显睫状体脱离、锯齿缘离断或虹膜根部形态异常等。24例人工晶状体悬挂植入术均手术顺利,无严重眼内感染或炎症等,未出现睫状体脱离或视网膜脱离等并发症,少数出现短暂眼内压增高。结论:选择3.0～6.0mm透明角膜切口行后房型三体折叠式人工晶状体植入并巩膜隧道无缝线固定悬挂术,是白内障超声乳化吸除术中弥补手术失误,治疗外伤性晶状体脱位或白内障,治疗先天性晶状体半脱位等疾病,提高视力的安全有效方法,远期疗效有待长期随访观察。

AIM： To observe the clinical effects of the sutureless intraocular suspended implantation of foldable three- piece acrylic aspheric posterior chamber lens （Tecnis） through clear corneal incision. ~ METHODS： A total of 21 patients （24 eyes） with non or unintact capsule that underwent the intraocular suspended implantation of foldable three-piece acrylic aspheric posterior chamber lens （~Tecnis） through clear corneal incision were observed and compared clinically to evaluate the clinical effects of this operative method. The observation and comparison were made on the parameters including visual acuity, intraocular reaction and lens situation by ultrasound biomicrography （UBM） before and after the operation. ~ RESULTS：A 3-12 months （6.5 months on average） follow up shows significant improvement （~ P〈 0.01 ） of both the uncorrected and corrected visual acuity of 24 eyes. The corrected postoperative visual acuity were 1.0-1.5 （8 eyes, 33.3%）, 0.5-0.9 （13 eyes, 54.2%） and 0.1- 0.4 （3 eyes, 12. 5%）, respectively. There was no statistical difference in the distance from the plane of artificial lens body to corneal endothelium, and the distance from ciliary process to corneal endothelia （P〉 0.05） in UBM photos after operations. All of 24 eyes were successfully conducted intraocular lens implantation without serious, intraocular infections or inflammations, no complications like cyclodialysis or retinal detachment. Only a few cases present temporary increase of intraocular pressure. ~ CONCLUSION. The sutureless intraocular suspended implantation of foldable three- piece acrylic aspheric posterior chamber lens （Tecnis） through 3.0 - 6.0ram clear corneal incision is an advisable remedy for capsule rupture failure during phaco- emulsification and an advisable operation for the dislocation of crystalline lens resulted from trauma or congenital cataract. The procedure can improve visual acuity safely and effectively without obvious complications. Its long-term effect needs long-term follow-up observation.