无线结巩膜缝线固定后房型人工晶状体的临床应用

Clinical application of knotless xleral-fixated posterior chamber intraocular lens

目的：评价无线结巩膜固定缝线后房型人工晶状体（intraocular lens,IOL）手术的安全性和稳定性。方法：回顾性分析2009-01/2014-10在沈阳何氏眼科医院因晶状体脱位、白内障术中后囊膜破裂、玻璃体切割术后无晶状体眼的患者35例39眼的临床资料,手术采用无结扎线结巩膜层间埋线方法固定后房型IOL,术中不制作巩膜瓣。观察和分析术前及术后最佳矫正视力（bestcorrected visual acuity,BCVA）、眼压、术后IOL稳定性和相关并发症等。结果：术后3mo,0.1≤BCVA〈0.3者9眼（23.1%）,0.3≤BCVA〈0.5者20眼（51.3%）,0.5≤BCVA〈0.8者6眼（15.4%）,0.8≤BCVA〈1.0者4眼（10.3%）;术中2眼出现虹膜根部出血,术后2wk内完全吸收;术后3眼出现一过性眼压升高,3眼出现角膜水肿,对症用药后均在1wk内恢复正常。术后无1眼出现角膜内皮失代偿、睫状体脱离、视网膜脱离及眼内炎等并发症。术后平均随访时间24（3~60）mo,未见IOL倾斜/脱位、缝线暴露、巩膜固定缝线处变薄和/或溶解等并发症的发生。结论：无线结巩膜缝线固定后房型IOL是无晶状体伴无充分囊膜支撑眼植入后房型IOL安全有效的治疗方法,减少了术后缝线相关并发症的发生。

AIM：To evaluate the safety and stability of knotless scleral- fixated posterior chamber intraocular lens（PCIOL）.METHODS：Thirty- nine eyes of 35 patients with dislocation of lens,capsule broken after cataract extraction or aphakic eyes after vitrectomy were retrospectively analyzed.They were undergone knotless scleral-fixated PCIOL without scleral flap from January2009 to October 2014 at He Eye Hospital in Shenyang.Preoperative and postoperative best-corrected visual acuity（BCVA）,intraocular pressure（IOP）,the stability of intraocular lens and complications were observed and analyzed.RESULTS：The BCVA of 9 eyes（23.1%） were 0.1 ≤BCVA0.3,20（51.3%） eyes were 0.3≤BCVA0.5,6eyes（15.4%） were 0.5≤BCVA0.8,and 4 eyes（10.3%） were0.8≤BCVA1.0 at 3mo postoperatively.Two eyes had mild iridemia intraoperatively,which were absorbed in2 wk.Three eyes had transient ocular hypertension,and three eyes had cornea edema postoperatively,all of them were cured through drug treatment in a week.There had no corneal decompensation,ciliary detachment,retinal detachment and endophthalmitis on any patient.The mean follow-up time was 24（3~60） mo.There was no complications of IOL tilting/dislocation,suture exposure,scleral attenuation or scleral dissolution postoperatively.CONCLUSION：The knotless scleral-fixated PCIOL is a safe and effective technique for aphakic eyes with deficient posterior capsular support,which reduces postoperative suture related complications.