晶状体半脱位手术226眼临床观察

Clinical efficacy of lens subluxation surgery(226 cases)

目的观察超声乳化晶体摘除联合张力环并Ⅰ期人工晶体植入术治疗晶状体半脱位的效果。方法①晶体半脱位〈1个象限的患者30例（43眼）,直接行超声乳化晶体核,吸净皮质,用旋转法植入（CTR）,囊袋内植入人工晶体。②晶体半脱位于1~2个象限的患者111例（152眼）,先用旋转法植入CTR,再超声乳化晶体核,吸净皮质,囊袋内植入人工晶体。③晶状体半脱位〉2个象限的患者21例（31眼）,应用囊袋固定型张力环,采用聚丙烯缝线将张力环缝合固定于巩膜,拉紧张力环缝线至晶状体囊袋居正中,抽吸晶状体皮质,植入折叠式人工晶状体。结果 162例226眼患者,术后随访1~12个月,人工晶状体基本保持正位,裸眼视力≥0.5者199眼（88℅）。结论超声乳化晶体摘除联合张力环并人工晶体植入,是晶体半脱位的首选治疗方法。脱位范围〈2个象限的患者可直接植入张力环,若脱位范围〉2个象限,则应缝线固定张力环。该手术方式可有效防止术后人工晶状体偏位的发生,大大提高患者的术后视力。

[ Objective ] To investigate the clinical efficacy of phacoemulsification combined with capsular tension ring （CTR） and intraoeular lens （IOL） implantation in curing the lens subluxation. [ Methods ] For patients with lens subluxation lower than 1 nuchal line 30 cases （43 eyes）, the lens core phaeoemulsification would be operated direct- ly with cortex absorbed and then the IOL would be implanted into the capsular bag after the CTR implanted by ro- tation method. For patients with lens subluxation between 1 and 2 nuehal line 111 cases （152 eyes）, the CTR would be implanted first. Then the phaeoemulsification and cortex absorption would be operated followed by the IOL im- plantation. For patients with lens subluxation higher than 2 nuchal line 21 cases （31 eyes）, the Auto-Ring would be applied into the surgery. In this situation, by making the other end of the polypropylene line goes through the scleral tunnel incision and get out from the iris, from the center of the transection suspensory ligament, the suture would be tensed to keep the lens capsular bag in the central position. Phacoemulsification to getting the crystal nucleus and cortex, then implanted the foldable intraoeular lens. [Results] After the surgery the results of 162 cases （226 eyes） were followed up for 1 to 12 months. It is obvious that the intraocular lens of all the patients remained in right place basically. Moreover, the postoperative uncorrected vision was above 0.5 in 199 eyeballs（88%）. [ Conclusions] Pha- coemulsification lens extraction combined with capsular tension ring and intraocular lens implantation is the pre- ferred method of treatment of lens subluxation. When the range of dislocation less than two quadrants, we can be di- rectly implanted capsular tension ring. But the patients with the range of dislocation was larger than two quadrants, should fixed capsular tension ring with suture. This surgical approach may be effective in preventing the occurrence of postoperative intraocular lens decentration, greatly improving the patient＇s visual acuity.