虹膜拉钩联合囊袋张力环在晶状体半脱位白内障患者术中的应用

Iris hooks and capsular tension ring for a subluxated lens in patients with cataract

目的 探讨虹膜拉钩联合囊袋张力环（CTR）在晶状体半脱位白内障患者术中应用的有效性和安全性.方法 回顾性病例研究.各种原因晶状体半脱位白内障患者22例（22眼）,其中外伤性白内障13眼,马凡氏综合征4眼,白内障超声乳化术中悬韧带离断3眼,不明原因者2眼.行3.2 mm透明角膜隧道切口及连续环形撕囊,150°穿刺刀做间隔90°的4个角膜缘穿刺切口,用4个一次性虹膜拉钩钩住撕囊边缘,植入CTR,超声乳化摘除白内障,囊袋内植入后房型人工晶状体.结果 22例晶状体半脱位白内障患者均顺利植入了囊袋张力环及后房型人工晶状体,术后患者视力得到提高,所有植入的入工晶状体均基本位于正位,无明显倾斜、偏位.术后随访6～36个月,最佳矫正视力0.2～0.4者6眼,0.5～0.8者11眼,0.8以上者5眼,4例患者出现后发性白内障,未见视网膜脱离等其他并发症.结论 在晶状体半脱位白内障超声乳化术中运用虹膜拉钩联合CTR植入,能提高手术安全性,减少手术并发症,是一种有效的白内障超声乳化手术辅助工具.

Objective To evaluate the clinical efficiency and safety of iris hooks and a capsular tension ring （CTR） for treatment of a subluxated lens in patients with cataract.Methods This study was comprised of 22 patients （22 eyes） with cataract and a subluxated lens.Among these patients：13 had traumatic cataracts,4 had Marfan syndrome,3 had a suspensory ligament broken during phacoemulsification,and 2 had unclear reasons for a subluxated lens.A 3.2 mm clear corneal incision was made with a continuous curvilinear capsulorhexis （CCC）.Four disposable iris hooks were inserted through the incisions and placed in the capsulorhexis to support the capsule and a CTR was implanted.Phacoemulsification and posterior chamber intraocular lens （IOL） implantation were performed.Results The capsular tension ring and IOL were smoothly implanted in all patients.After the operation,all patients had improved visual acuity,and the intraocular lens was basically in the normal position without tilting or obvious decentration in all the eyes.The follow-up period lasted for 6-36 months.Best corrected visual acuity （BCVA） was 0.2-0.4 in 6 eyes,0.5-0.8 in 11 eyes,and over 0.8 in 5 eyes.Four of the eyes were examined at a follow-up of one year or more after cataract surgery.No serious complication such as retinal detachment was seen in any patient.Conclusion The use of iris hooks and CRT in cataract patients with a subluxated lens extracted by phacoemulsification can improve stability and reduce complications.This procedure is an effective supplemental device in cataract surgery.