23G玻璃体切割联合小切口无线结缝合固定治疗IOL脱位玻璃体腔应用

The use of 23G PPV and knotless SF PCIOL to treat PC IOL dislocating into the vitreous cavity

目的 评价23G玻璃体切割联合小切口无线结巩膜固定后房型人工晶状体治疗人工晶状体脱位于玻璃体腔的有效性及稳定性.方法 回顾性分析2012年3月至2014年9月因人工晶状体脱位于玻璃体腔于沈阳何氏眼科医院治疗9例9只眼的患者资料,手术行23G玻璃体切割取脱位人工晶状体于前房,由上方2.8 mm透明角膜切口行人工晶状体攀眼外结扎,人工晶状体巩膜固定应用无线结的巩膜层间埋线方法固定.观察术前术后最佳矫正视力、散光、眼压、前节炎症及眼底情况,术中术后并发症,及缝合人工晶状体的稳定情况.结果 术后3个月,最佳矫正视力为0.6～0.7者5例,0.8～1.0者4例;术前角膜散光（-0.85±0.43）D,术后3个月（-0.97±0.39）D,差异无统计学意义（t=0.45,P ＞0.05）.术前3例患者因玻璃体疝高眼压,术后9例患者眼压均正常,术后前节炎症不明显,跟底稳定.术中除1例虹膜根部出血外未见其他并发症;随访6～30个月,平均15个月,无人工晶状体倾斜或再次脱位,无巩膜变薄、溶解及缝线暴露等并发症的发生.结论 改良的小切口无线结巩膜固定后房型人工晶状体联合23G玻璃体切割治疗人工晶状体脱位于玻璃体腔安全有效,术后人工晶状体稳定性好,无缝线有关的并发症。

Objective To evaluate the safety and stability of 23 gauge pars plana vitrectomy （23G PPV） and modified knotless scleral-fixated posterior chamber intraocular lens （SF PCIOL） in curing posterior chamber intraocular lens （PC IOL） dislocated into the vitreous cavity.Methods A retrospective analysis of 9 patients （9 eyes）,who underwent modified knotless SFPCIOL and 23G PPV between March 2012 and September 2014,were enrolled in this study.The dislocating IOL was moved into the anterior chamber during the 23G PPV,and the IOL haptic was pulled out of the eye through the superior 2.8mm corneal incision and fixated,and the IOL was fixated intra the scleral by the technique of knotless SF PCIOL.The following details were recorded：pre-and postoperative best-corrected visual acuity （BCVA）,astigmatism,intraocular pressure （IOP）,the inflammation of the anterior chamber and the situation of the fundus,intraoperative and postoperative complication,and the stability of the intraocular lens.Results The best corrected visual acuity （BCVA） was 0.6-0.7 in 5 eyes,and 0.8-1.0 in 4 eyes at 3 months after postoperative,the mean corneal astigmatism was （-0.85±0.43） diopter preoperatively and （-0.97±0.39） diopter at 3 months after the surgery,and no significant differences were observed （t =0.45,P 〉0.05）.Three eyes with vitreous hernia had ocular hypertension preoperative,and all the patients achieved normal intraocular pressure after the surgery;the inflammation of the anterior chamber was minor and the fundus was stable;Bleeding of the iris root happened to one of the patient,and there were no other complication happened in any of the patient during the surgery.The median follow-up was 15 months （min：6 months;max：30 months）,no IOL tilting or dislocation,no scleral attenuation,dissolution or suture breakage were founded in this study.Conclusions This technique of modified knotless SF PCIOL and 23G PPV is a safe and effective procedure for PC IOL dislocated into vitreous cavity cases,it achieves the PC IOL centration stability,and minimizes postoperative suture-related complication.