硅油填充眼白内障超声乳化人工晶状体植入术的探讨

Investigation of the intraocular lens implantation in the cataract surgery of silicon oil filled eye

目的探讨在伴有并发性白内障的硅油填充眼行白内障超声乳化联合玻璃体腔硅油取出手术时，比较在取出玻璃体腔硅油前和取出玻璃体腔硅油后植入人工晶状体的安全性及临床效果。方法临床病例对照研究。选取2012年6月至2014年6月在广西壮族自治区人民医院进行手术的伴有并发性白内障的硅油填充眼患者67例（67只眼）。将病例分为两组，A组行白内障超声乳化后，植入人工晶状体，再取出玻璃体腔硅油；B组行白内障超声乳化后，取出玻璃体腔硅油，再植入人工晶状体。观察比较两组术中操作的简易程度，人工晶状体是否粘附硅油，术后视力恢复及术中术后并发症等。结果随访了3～22个月，术后3个月视力大于0．1者，A组16只眼，B组6只眼，两组比较差异有统计学意义（P〈0．05）；两组患者术后第一天及一周眼压偏低，两组比较无统计学意义（P〉0．05）；B组出现3例术后高眼压，3例人工晶状体未能植入囊袋；11例人工晶状体表面可见少许硅油粘附。所有患者均无角膜内皮失代偿、硅油泡残留、人工晶状体移位和玻璃体出血等并发症。结论伴有并发性白内障的硅油填充眼行白内障超声乳化后，采用先植入人工晶状体，再行玻璃体腔硅油取出的手术方式更安全、有效。

Objective To evaluate the therapeutic effect of intraocular lens implantation before or after silicone oil removal in silicone oil-filled eyes combined with complicated cataract who underwent surgical management of complex retinal detachment by vitrectomy. Methods All 67 cases （67 eyes）, who were silicone oil-filled eyes combined with complicated cataract, were randomly divided into two groups. Group A： intraocular lens implantation before silicone oil removal; group B： intraocular lens implantation after silicone oil removal. The rate of silicone adhesive intraocular lens, visual acuity, and intraoperative and postoperative complications were compared between the two groups. Results Statistically significant differences were found between groups in vision at 3 months after operation. At postoperative first three days, the intraocular pressure was slightly low in both two groups, and no significant statistical difference was detected. Two eyes in group B weren＇t implanted intraocular lens into capsular bag, moreover, a little silicone oil adhere to the surface of the intraocular lens in eleven eyes. No incidence of complication occurred, such as persistent corneal endothelial decompensation, silicone oil bubble residual, intraocular lens dislocation, vitreous hemorrhage. Conclusions These results suggest that removing silicone oil after implanting an intraocular lens for silicone oil-filted eyes with vitrectomy who have had phacoemulsification is a safe and effective method.