白内障合并真性囊膜剥脱综合征手术方式探讨

Surgical methods for cataract with true exfoliation of lens capsule

目的探讨手术治疗白内障合并真性囊膜剥脱综合征的安全性。方法回顾性分析2010年3月至2015年1月期间在河北省眼科医院白内障科就诊的白内障合并真性囊膜剥脱综合征患者4例（5眼）,其中3眼悬韧带正常,我们在撕囊和正常超声乳化手术过程中未发现任何异常;另外2眼合并晶状体不全脱位,我们使用4个虹膜拉勾固定囊袋,囊袋内预劈技术将晶状体核劈成8块,扭动超声乳化核及吸除皮质后,囊袋内植入张力环及人工晶状体。比较术前及术后最佳矫正视力、超声乳化总时间、灌注液消耗量、角膜中央内皮细胞密度、角膜内皮细胞丢失率,观察囊袋及人工晶状体有无偏心移位以及并发症的发生情况。结果术后3个月最佳矫正视力0.8者2眼,0.6者1眼,0.5者2眼,术后3个月最佳矫正视力均较术前增加。晶状体超声乳化时间为30.2~52.6（45.4±9.1）s。灌注液消耗量为63.18~80.26（71.97±6.94）mL。术前角膜中央内皮细胞密度2163~2892（2505.2±317.4）mm-2,术后3个月为2075~3023（2415.4±308.1）mm-2。角膜内皮细胞丢失率为3.59%。术后5眼测得人工晶状体偏中心量为0.12~0.46（0.30±0.15）mm。5眼人工晶状体均成功植入囊袋内,术中未出现后囊膜破裂、悬韧带损伤或加重,术后第1天角膜均透明,远期未出现囊袋收缩、后囊膜混浊等并发症。结论采用囊袋内预劈核联合虹膜拉勾囊袋固定和囊袋内植入张力环,可以增加合并真性囊膜剥脱综合征白内障手术的安全性。

Ohjeetive To study the safety of surgical methods for cataract with true exfoliation of the lens capsule. Methods This study was comprised of 4 cases （5 eyes） with true exfoliation of the lens capsule in our hospital from March 2010 to Janu- ary 2015. Nothing was happened to the 3 eyes with the normal ciliary zonule during the capsulorhexis and phacoemulsiflcation. For another 2 eyes with lens subluxation, 4 iris retractors were used to hook the capsular edge in order to reinforce the lens capsule. The pre-chopping technique was used to split the nucleus into 8 pieces. The capsular tension ring and intraocular lens were implanted in the lens capsule after torsional phac- oemulsification and clearing the cortex. The preoperative best corrected visual acuities with their postoperative best corrected visual acuities were compared. The U/S total time, estimated fluids and average central corneal endothelial cell counts were analyzed. The corneal endothelial cell loss ratio was counted. The complications such as capsular and IOL dislocation were observed. Results The postoperative best corrected visual acuities in 2 eyes was 0.8,in 1 eye was 0.6,in 2 eyes was 0.5. Their postoperative best corrected visual acuities were improved after 3 months. The U/S total time was 30.2 - 52.5 （45.4 ± 9.1 ） s. The estimated fluid was 53. 18 - 80. 25 （ 71.97 ± 6.94 ） mL. Average central corneal endothelial cell counts was （2505.2 ± 317.4）cells · mm-2, which at postoperative 3 months was （2415.4 ± 308.1 ）cells · mm 2. Corneal endothelial cell loss ratio was 3.59%. The IOL offset of 5 eyes was 0. 12 - 0.45 （ 0.30 ± 0. 15 ） mm. The in-traocular lens were successfully implanted in 5 eyes. No complication such as posterior capsule rupture or ciliary zonule damage was occurred. All of the cornea were transparent after operation. Long term complication such as capsular contrac- tion and the posterior capsule opacification was not occurred. Conclusion The pre-chopping technique with the iris re- tractors and capsular tension ring is helpful for the treatment of true exfoliation of lens capsule with lens subluxation.