眼内反应与人工晶体关系的临床研究

The clinical study on the relationship of endophthalmitis and IOL

目的：分析在人工晶体植入后眼内炎症反应的原因,澄清这种反应与眼内炎的本质区别,推测可能出现的预后,提出预防和治疗的方法。方法：在术者相同、术式相同（超乳或非超小,切口3.2-5.5mm,完全囊袋内植入,完全或基本全覆盖）,眼内灌注液相同（BSS,量40-100m L）,黏弹剂相同（上海其胜生物）,不用眼内缩瞳剂等,所不同的即为人工晶体（包括RS-55B、肝素处理晶体、亲水性折叠晶体）,进行回顾性比对。在过去3年的3000余例白内障手术中采集850眼符合标准的进行均衡性检验,入选病例为单纯老年性白内障,患有其它眼病、糖尿病、明显皮质残留、前房出血、虹膜损伤、手术时间较长除外。并根据人工晶体的不同分为3组,＂A＂组RS-55B为300眼,＂B＂组肝素处理晶体330眼,＂C＂组折叠晶体220眼。结果：＂A＂组5眼（1.5%）且程度较重,全部有膜形成和玻璃体的反应,＂B＂组0眼（0%）,＂C＂组1眼（0.45%）程度极轻,仅局部用药即在一周内完全恢复且不保留任何痕迹。结论：在手术技巧非常娴熟,手术时间越来越短,前房稳定良好,器械进入前房越来越少的今天眼内炎症反应与晶体的相关性越来越强,所以选择优质的人工晶体对获得满意的手术效果至关重要。

Objective： To analyze the cause of endophthalmitis after IOL implantation,and to distinguish the essential difference between this reaction and common endophthalmitis; to speculate that the prognosis may occur,then proposed methods of prevention and treatment. Methods： Retrospective analysis was deployed on the same operation doctor and mode,the same BBS,the same Sodium hyaluronate,just different in IOL. In the past 3 years,we collected 850 eyes from 3000 cases which were compliant to make equalization test. Only age- related cataract were elected except for any other eye diseases,diabetes,obvious residual cortex,hyphema,iris injury,and long time operation. And Three groups were divided depending on the IOL： A group with RS- 55B（ 300eyes）; B group with IOL heparin- treated surface（ 330eyes）; C group with foldable IOL（ 220eyes）. Results： 5 eyes（ 1. 5%） in group A have serious response,characterized by membranous and vitreous inflammation; B group have no adverse reactions（ 0%）; 1eye（ 0. 45%） in C group came to a mild reaction and then fully recovered within a week by local application. Conclusion： We have well operation skill and use less time in operation to keep stable on anterior chamber. So how to chose IOL to obtain satisfactory results of operations is critical when endophthalmitis associated with IOL growing increasingly strong correlation.