马凡综合征晶状体不全脱位手术中虹膜拉钩的应用

Surgery with the use of iris retractors for subluxation of lens in Marfan syndrome

目的评价在马凡综合征晶状体不全脱位手术中虹膜拉钩的应用效果。方法马凡综合征晶状体不全脱位12例（20只眼），晶状体脱离范围均超过180°。术中连续环形撕囊后，使用2—3个虹膜拉钩钩住撕囊边缘，以稳定晶状体囊袋，完成晶状体超声乳化吸出后，再将其余晶状体囊袋全部撕除，最后睫状沟缝线固定人工晶状体（IOL）。术后随访6～12个月，观察视力、IOL位置及手术并发症。结果20只眼均顺利完成手术。术后6个月最佳矫正视力0．3～0．6者14只眼（70．00％），≥0．8者6只眼（30．00％），与术前的数指～0．2相比有显著提高（Z=-5．44，P=0．00）。术后随访过程中，20只眼IOL均居中且稳定，无视网膜脱离、黄斑水肿或角膜失代偿等并发症发生。结论对马凡综合征晶状体不全脱位，术中应用虹膜拉钩辅助晶状体超声乳化手术可维持晶状体囊袋的稳定及手术过程的安全。

Objective To evaluate the clinical efficiency of the application of iris retractors for the treatment of subluxation of lens in patients with Marfan ＇ s syndrome. Methods This study comprised 20 eyes of 12 patients with Marfan＇ s syndrome and subluxation of lens. The ranges of lens sublnxation were all more than 180 degrees. After continuous curvilinear capsulorrhexis, 2-3 iris retractors were used to drag and fixate the edge of eapsulorhexis opening. Following phacoemulsification and aspiration, the residual lens capsular bag was removed. Anterior vitreous resection was performed if vitreous prolapsed after removal of the capsular bag. Finally, the intraoeular lens （IOL） was sutured and fixated at the ciliary sulcus. The visual acuity, the position of IOLs and surgical complications were observed for 6-12 months. Results All the 20 eyes of 12 cases underwent successful surgery. Six months after surgery, the best corrected visual acuity was at 0.3-0.6 in 14 eyes （70.00%） and more than 0.8 in 6 eyes （30.00%）. Postoperative visual acuity significantly improved compared with preoperative visual acuity （ finger counting-0.2 ） （ Z = - 5.44, P = 0.00 ）. The IOLs were well centered in all cases during follow-up. No severe complication such as retinal detachment, macular edema or corneal endothelium decompensation was observed. Conclusion Application of iris retractors for patients of Marfan＇ s syndrome with subluxation lens can provide excellent intraoperative capsular stability and facilitate the manipulation during operation.