人工晶状体置换原因临床分析

Analysis on the causes of intraocular lens exchange

目的分析人工晶状体(IOL)置换的原因及预防对策。设计回顾性病例系列。研究对象2012年4月至2013年5月在北京大学第三医院眼科因各种原因行IOL置换者28例(28眼)。方法对患者的既往病史、IOL置换原因、IOL及囊袋情况进行描述性归纳分析,计算IOL置换原因构成比。针对不同原因研究预防对策。主要指标患者的既往病史、IOL置换原因、IOL及囊袋情况。结果 IOL置换原因包括:前房型IOL致大泡性角膜病变10眼(35.70%)。IOL脱位14眼(50.00%),其中IOL脱位于玻璃体10眼(35.70%),高度近视囊袋半脱位2眼(7.14%),脱位于玻璃体伴有缺血性视神经病变2眼(7.14%)。屈光异常2眼(7.14%),包括儿童IOL植入术后高度近视1眼(3.57%),高度近视IOL测量错误1眼(3.57%)。激光导致IOL损伤2眼(7.14%)。预防措施包括提高手术技巧,减少术中瞬间高眼压,较少悬韧带损伤,减少后囊破裂几率,掌握后囊破裂后IOL植入指征,正确计算IOL度数,提高儿童白内障术后近视控制技术,避免植入房角固定型前房IOL等。结论 IOL置换原因以前房型IOL导致大泡性角膜病变和IOL脱位为多。提高手术技巧,避免植入房角固定型前房IOL等可有助于减少IOL置换的发生。

Objective To investigate the causes and precaution of intraocular lens （IOL） exchange. Design Retrospective case series. Participants 28 eyes which underwent IOL exchange in Peking University Third Hospital from April, 2012 to May, 2013. Methods The medical history, the causes and IOL dislocation, capsular rupture condition of these patients and precaution measures were analyzed. Main Outcome Measures Causes of IOL exchange, IOL dislocation and posterior capsule rupture condition. Results The causes of IOL exchange included bullous keratopathy with angle supported anterior chamber IOL （35.70%）, IOL dislocation （50.00%） included complete dislocation in vitreous （35.70%） and dislocation with ischemic optic neuropathy （7.14%） and luxation with high myopia （7.14%）, refractive error （7.14%） included one high myopia eye with wrong calculation IOL diopter and one eye high myopia shift after pediatric cataract surgery, IOL damage due to laser （7.14%）. The precaution included improving surgery technique, avoiding implanting angle supported anterior chamber IOL, avoiding instantly increasing intraocular pressure during the surgery, correctly calculating IOL diopter etc. Conclusion The main causes of IOL exchange include IOL dislocation and bullous keratopathy induced by the angle supported anterior chamber IOL. It will be helpful to reduce the rate of IOL exchange if we can improve surgery techniques, avoid increasing intraocular pressure instantly, avoid angle supported anterior chamber IOL, increase laser therapy techniques, select suitable calculation formula for high myopia etc.