外伤性白内障晶状体囊夹持人工晶状体植入术

The anterior capsule holding technique in IOL implantation for traumatic cataract

目的探讨晶状体前囊夹持法人工晶状体固定术用于外伤性白内障中晶状体后囊大面积破裂者的临床效果。方法对96例（96眼）角膜穿孔伤伴外伤性白内障二期白内障摘出后房人工晶状体植入术，根据患者前后囊破损严重程度采取人工晶状体的不同固定方式而分为3组：A组，64眼，囊袋内植入术；B组（试验组），12眼，前囊夹持法植入术，即用前囊的撕囊口夹持人工晶状体而固定之；C组，20眼，睫状沟固定植入术。术后随访6—36个月，观察手术效果及术后并发症发生情况。结果术后6个月时，矫正视力／〉0．3者：A组31眼（48．44％），B组6眼（50．00％），C组6眼（30．00％）。术后并发症：A组角膜水肿15眼（23．44％），葡萄膜反应15眼（23．44％），人工晶状体偏心2眼（3．13％），脱位2眼（3．13％），瞳孔夹持1眼（1．56％），晶状体后囊浑浊13眼（20．31％），视网膜脱离1眼（1．56％）。B组角膜水肿3眼（25．00％），葡萄膜反应3眼（25．00％），未出现人工晶状体偏心，脱位，瞳孔夹持，晶状体后囊浑浊或视网膜脱离者；C组角膜水肿6眼（30．00％），葡萄膜反应8眼（40．00％），人工晶状体偏心3眼（15．00％），脱位2眼（10．00％），瞳孔夹持3眼（15．00％），视网膜脱离1眼（5．00％），无晶状体后囊浑浊者。结论前囊夹持法人工晶状体植入术，操作简单，减少了术后并发症，适用于外伤性白内障中晶状体后囊大面积破裂，但是能完成前囊居中连续环形撕囊的患者。

Objective To investigate the clinical effect of the anterior capsule holding of intraocular lens for traumatic cataract with large grea of posterior capsule rupture. Methods All the 96 eyes of 96 patients with traumatic cataract caused by corneal penetrating injury received corneal suturing first and then cataract extraction and lens implantation. All the cases were divided into three groups according to the severity of anterior and posterior capsule rupture and lens fixation methods. Group A, posterior capsule holding, 68 eyes; group B , the anterior capsule holding, 12 eyes; and group C, ciliary sulcus fixation, 20 eyes. The follow-up time was 6 to 36 months. The surgical effect and postoperative complications were observed. Results At the 6 months after the surgery, the best corrected visual acuity （BCVA） better than 0.3 was in 31 eyes （48.44%） in group A, in 6 eyes （50.00%） in group B and 6 eyes （30.00%） in group C. There were no any serious operative complications in three groups. The postoperative complications in group B included corneal edema in 3 eyes （25.00%）, uveal inflammation in 3 eyes （25.00%）, and no lens decentration, pupil block, artificial lens dislocation, posterior capsule opacity （PCO） or retinal detachment （RD） occurred. Conclusion The intraocular lens implantation by anterior capsule holding for traumatic cataract with large area of posterior capsule rupture caused by corneal perforation is simple and effective in the cases in whom the continuous circular capsulorhexis can be performed successfully.