麻风患者小瞳孔下白内障囊外摘除并后房型人工晶状体植入的相关危险因素

Risk factors of extracapsular cataract extraction and posterior chamber intraocular lens implantation through microcoria in leprosy patients

目的:探讨麻风患者小瞳孔下白内障手术方法及相关危险因素分析及预防,使手术并发症减少到最低限度。方法:对72例83眼麻风患者小瞳孔白内障行上下瞳孔括约肌剪开,软分离并钝分离剪开松解推动虹膜向周边移位,扩大瞳孔完成白内障囊外摘除并人工晶状体植入。术后进行回顾性分析手术前后最佳视力与手术并发症。结果:术后6mo随访,最佳矫正视力≥0.5者20眼(24%),0.1~<0.5者33眼(40%),<0.1者14眼(17%),无变化16眼(19%)。术前和术后视力比较有统计学意义(χ~2=99.04,P<0.01)。术后并发症:葡萄膜炎26眼(31%),后囊破裂14眼(17%),后发性白内障21眼(25%),继发青光眼13眼(16%)。结论:麻风患者因病程长,麻风反应并长期存在葡萄膜炎导致虹膜血管的神经损害和瞳孔闭锁的现状,一般手术难度大,术后并发症多而复杂致术后视力恢复较差。

AIM：To study the surgery method,risk factors and prevention of extracapsular cataract extraction（ECCE）and posterior chamber intraocular lens（PC-IOL）implantation through microcoria in leprosy patients in order to minimize the surgical complications.METHODS：Totally 72 leprosy patients（83 eyes） with cataract were treated by cutting the sphincter muscle of pupil to enlarger the pupil,then performing ECCE and PCIOL.The visual acuity and complications were retrospectively analyzed.RESULTS：At 6mo postoperatively,best corrected visual acuity was ≥0.5 in 20 eyes（24%）,0.1 to 0.5 in 33 eyes（40%）,0.1 in 14 eyes（17%）,no change in 16 eyes（19%）.The postoperative complications：uveitis in 26 eyes（31%）,posterior capsular rupture in 14 eyes（17%）,posterior capsular opacification in 21 eyes（25%）,secondary glaucoma accounted in 13 eye（16%）.CONCLUSION：Because of long course,lepra reaction and persistent iritis,the leprosy patients are suffered from nerve damage and atretopsia,which make the surgery hard to com plan,the complications increased,and the postoperative visual acuity is poor.