有晶状体眼虹膜固定型人工晶状体植入术后远期人工晶状体脱位临床分析

Clinical analysis of long-term artificial lens dislocation after phakic irisfixated intraocular lens implantation

目的探讨有晶状体眼虹膜固定型有晶状体眼人工晶状体(phakic intraocular lens,PIOL)植入术后远期人工晶状体脱位、移位情况及原因分析。方法对我中心2005至2013年开展的Verisyse PIOL植入术矫正高度近视患者52例(104眼)进行术后平均6.5 a随访性研究,对其中发生PIOL脱位、移位患者的临床资料进行回顾性分析。结果 104眼中8眼发生PIOL不全脱位,其中1眼是因为拳头打伤颞侧晶状体袢脱落,2眼因皮球打伤眼睛致一侧晶状体袢脱落,1眼因撞击后出现鼻侧晶状体袢脱落,2眼是搬动重物一侧晶状体袢脱落,1眼是自然分娩后出现双侧晶状体袢脱落并PIOL脱落入前房,1眼是夹持虹膜部位退行性改变致晶状体脱位。7眼发生PIOL下移,下移程度>0.5 mm,其中晶状体袢单侧下移2眼,双侧下移5眼。8眼PIOL脱位中6眼行PIOL再固定术,2眼行PIOL取出术。结论 PIOL脱位与术后眼部外力及外伤、眼压波动、手术时固定虹膜组织的程度不够、所夹取的虹膜组织发生脱色素和退行性变有关,PIOL本身有自身的重量,长期作用会发生向下移位或襻脱离。

Objective To explore the long-term postoperative dislocation and displacement of intraocular lens after Verisyse phakic intraocular lens（ Verisyse PIOL） implantation,and analyze the reasons of dislocation and displacement of intraocular lens. Methods Based on the random survey carried out on 52 cases who have received Verisyse PIOL implantation for correction of high myopia in our center from 2005 to 2013,the follow-up time averaged 6. 5 years,the cases of dislocation and displacement of intraocular lens were retrospectively analyzed. Results In104 eyes,PIOL in 8 eyes appeared incomplete dislocations,including 1 eye with temporal crystal loop loss resulted from punching,2 eyes with side crystal loop losses induced by ball-beating,1eye with nasal crystal loop loss due to impact,2 eyes with side crystal loop losses during moving heaving stuff,1 eye with bilateral crystal loop off after natural childbirth with PIOL off into the anterior chamber,1 eye with crystal dislocation induced by degenerative changes of clamped iris,7 eyes with PIOL moving downwards more than 0. 5 mm,among which 2 eyes unilaterally moving and 5 eyes bilaterally moving. Conclusion The PIOL dislocation results from such factors as external force and trauma postoperatively received by the ocular tissues,intraocular pressure fluctuations,less enough irisfixated phakic during operation,clip of iris tissue off pigment and degeneration,and the downward dislocation or crystal loop off caused by the PIOL its own weight.