玻璃体手术后无晶状体眼的二期人工晶状体植入术

Secondary intraocular lens implantation in aphakic eyes following vitrectomy

目的 评价因复杂眼外伤或视网膜脱离行玻璃体手术和晶状体切除术后 ,二期手术植入人工晶状体 (intraocular lens,IOL)的视力效果、手术技术及其安全性。 方法 对在 1996年 11月至 1999年 12月之间在我院进行该手术的 32例 (32只眼 ,每例均为单眼 )行回顾性分析。二期手术中应用经睫状体平部的眼内灌注 ,并根据晶状体囊膜完整性选择不同类型的 IOL。 结果 本组包括复杂眼外伤 30例 (眼后节异物伤 15例 ,穿通伤伴外伤性眼内炎及玻璃体积血各 6例 ,钝挫伤伴晶状体脱位 3例 ) ;原发性视网膜脱离 2例。均接受过玻璃体切割、晶状体切割 ,或眼内异物取出、角膜缝合等。 2次手术的间隔为 1～ 16个月 ,平均(6 .8± 3.7)个月。在 2 5例晶状体囊环完整或存留 2 / 3以上的眼植入后房型 IOL于睫状沟内 ;5例作了 IOL的透巩膜缝线固定术 ;植入前房型或带虹膜 IOL 各 1例。 5例同期放出硅油。手术后 2 9例视力提高。主要并发症为角膜水肿及低眼压。 结论 在玻璃体手术后的二期手术中 ,应用眼内灌注和适当的 IOL 植入 ,可使经选择的无晶状体眼安全获得较好的视力恢复。

Objective To evaluate the visual results,surgical technique and safety of secondary intraocular lens (IOL) implantation in aphakic eyes following vitrectomy and lensectomy for complicated ocular trauma or retinal detachment. [WT5”HZ]Methods The clinical records of 32 cases (32 eyes),received these surgeries during November 1996 and December 1999,were reviewed retrospectively.During the secondary operation,intraocular infusion through the pars plana was performend and the type of IOL was chosen based on the integrity of lens capsule. [WT5”HZ]Results The study included 30 eyes suffering from trauma (foreign bodies in 15 eyes,penetrating injury with traumatic endophthalmitis and with vitreous hemorrhage in 6 eyes respectively,blunt trauma with lens dislocation in 3 eyes),and 2 eyes with primary retinal detachment.Those eyes all received vitrectomy,lensectomy,and/or removal of foreign bodies and corneal suture.The interval of two operations ranged from 1 to 16 months with an average of 6.8±3.7 months.Posterior chamber IOL was implanted in the ciliary sulcus in 25 eyes with a whole or 2/3 of lens capsule,trans scleral suture fixation of IOL in 5 eyes,anterior chamber IOL and IOL with artificial iris in one eye respectively.Silicone oil was removed in 5 eyes during the secondary operation.Post operative visual improvement was achieved in 29 eyes.Main complications were corneal edema and low intraocular pressure after operation. [WT5”HZ]Conclusion Intraocular infusion and proper IOL implantation during the secondary operation following vitrectomy can provide selected aphakic eyes with better visual recovery.