先天性无虹膜合并白内障手术疗效观察

Clinical study of a complex cataract surgery for congenital aniridia combined with cataract

目的 评价先天性无虹膜合并白内障患者行超声乳化白内障摘除联合晶状体囊袋张力环及黄色后房折叠型人工晶状体（IOL）植入，并配戴美瞳接触镜的治疗效果。方法 前瞻性系列病例研究。对10例（17眼）先天性无虹膜合并白内障患者施行白内障手术，采用3.2 mm透明角膜切口，连续环形撕囊直径小于6 mm，超声乳化后，植入晶状体囊袋张力环及黄色后房折叠型IOL，术后配戴美瞳接触镜。患者年龄4-50岁，平均（25.4±14.8）岁。术前最佳矫正视力（BCVA）0.05-0.1。眼压（IOP）8-24 mmHg（1 mmHg=0.133 kPa），平均（16.4±3.9）mmHg。角膜内皮细胞计数1 825-3 829个/mm^2，平均（3 280±473）个/ mm2。仅1例患者具有部分虹膜，其余患者均仅有虹膜根部，晶状体完全暴露，晶状体悬韧带可见，无晶状体脱位，晶状体混浊表现为不均匀花瓣状，患者畏光症状明显，有不同程度眼球震颤，角膜及眼底大致正常。应用配对t检验比较手术前后IOP、角膜内皮变化情况。结果 手术均顺利完成，植入IOL度数为19.50-30.00 D，平均（24.44±4.30）D。随诊时间1-18个月，末次随访BCVA 0.1-0.7，均较术前提高；患者自觉畏光症状明显减轻，配戴美瞳后畏光症状减轻更为明显。所有病例最后一次复查时角膜均清亮，未见接触镜所致角膜感染症状。所有IOL被囊袋包裹良好，位置趋中。2例（4眼）患者随诊至术后6个月时晶状体囊袋机化明显，后囊混浊经YAG激光治疗后已形成人工瞳孔。术后IOP为（18.1±3.6）mmHg，未见继发性青光眼。角膜内皮细胞计数为（2 669±850）个/mm^2，无继发性角膜内皮失代偿病例。结论 应用超声乳化白内障摘除联合晶状体囊袋张力环植入、后房折叠型黄色IOL植入和配戴美瞳接触镜治疗先天性无虹膜合并白内障效果良好，术后视力有一定程度提高，明显减轻畏光等不适症状。

Objective To evaluate the therapeutic effect of a complex surgery that included phacoemulsification, an implanted posterior chamber folding, yellow intraocular lens（IOL） and an embedded capsular tension ring for patients with congenital aniridia complicated with cataract; tinted contact lenses were given postoperatively. Methods This was a prospective case series study. Ten patients （17 eyes） agreed to undergo complex cataract surgery. The surgery used a 3.2 mm clear corneal incision and continuous circular capsulorhexis. The capsulorhexis diameter was less than 6 mm. A capsular tension ring and HOYA yellow, folded posterior chamber IOL were implanted during surgery. All patients wore tinted contact lenses postoperatively. The patients ranged in age 4-50 years （mean age： 25.4±14.8 years）. The best corrected visual acuity （BCVA） preoperatively was 0.05-0.1. Intraocular pressure （IOP） was 8-24 mmHg （mean IOP： 16.4±3.9 mmHg）. Corneal endothelial cell density was 1 825-3 829/mm^2 （mean： 3 280±473）. All patients had only an iris root except for one patient who had a partial iris. The lens was completely exposed and the lens suspensory ligament could be seen. There was no lens dislocation. Lens opacity was an uneven petal shape. All patients definitely experienced photophobia and had different degrees of nystagmus. The cornea and fundus were almost normal. A paired t test was used to compare intraocular pressure, and corneal endothelial changes before and after the surgery. Results All phacoemulsifications were completed smoothly by the same ocular surgeon. The mean IOL correction was 24.44±4.30 D （19.50-30.00 D）. BCVA was 0.1-0.7, 1-18 months postoperatively. All patient photophobia symptoms significantly decreased and this was more apparent when patients were wearing the tinted contact lens. The cornea was clear at the final postoperative follow-up and there were no symptoms of corneal infection. The lens capsule held all IOLs in place and the lenses were in a good neutral position. IOP was 18.1±3.6 mmHg. There was no secondary glaucoma. Corneal endothelial cell density was 2 669±850/mm^2. There was no secondary corneal endothelial decompensation. Conclusion The theraputic effect is good when congenital aniridia complicated with cataract is treated with a complex surgery that included phacoemulsification, an embedded capsular tension ring and an implanted tinted folding posterior chamber IOL. The tinted contact lenses were worn postoperation. This procedure can definitely improve postoperative visual acuity and significantly reduce photophobia symptoms.