改良式大切口白内障囊外摘出联合人工晶状体植入术治疗高度近视合并白内障

Modified large-incision manual cataract extraction combined with IOL implantation for high myopia with cataract

目的评价改良式大切口白内障囊外摘出联合人工晶状体植入术治疗高度近视合并白内障的疗效及安全性。方法对28例(32眼)高度近视合并白内障患者行改良式大切口白内障囊外摘出联合人工晶状体植入术,核硬度Ⅲ级20眼,Ⅳ级11眼,Ⅴ级1眼,术后随访212个月,观察视力、屈光度及手术并发症。结果所有32眼中,28眼的术后最佳矫正视力明显优于术前;4眼术后最佳矫正视力无改善,眼底检查均发现较严重的高度近视性眼底病变。术后和术前最佳矫正视力(logMAR)为0.84±0.71和1.43±0.73,等效球镜度数(-1.86±1.41)D和(-15.33±5.03)D,差异均有统计学意义(均为P<0.05)。术中发生部分悬韧带离断者1眼,1眼娩核时出现虹膜出血;术后轻度角膜水肿11眼、前房积血1眼、短暂性高眼压1眼、葡萄膜炎症反应3眼,经处理均在1周内病变消失。术后1眼人工晶状体植入于睫状沟,其余病例人工晶状体均植入囊袋内。随访期间未发现人工晶状体偏移。结论改良式大切口白内障囊外摘出联合人工晶状体植入术安全有效,适用于治疗高度近视合并白内障。

Objective To evaluate the effectiveness and safety of modified large- incision manual cataract extraction combined with intraocular lens （IOL） implantation for high myopia with cataract. Methods Twenty-eight patients （32 eyes） of high my- opia with cataract underwent modifed large-incision manual cataract extraction com- bined with IOL implantation. The nuclear hardness of 20 eyes were in degree Ⅲ, 11 eyes were in degree Ⅳ, 1 eye was in degree V. The follow-up time was form 2 months to 12 months, the visual acuity, refraction and complications were observed and analyzed. Resuits In 32 eyes, the postoperative best corrected visual acuity （BCVA） was better than pre-operation in 28 eyes,4 eyes had no any improvement,in which the server high myopic fundus disease was found. The preoperative and postoperative BCVA were （ 1.43 ± 0. 73 ） logMAR and （ 0. 84 ± 0. 71 ） logMAR, and the sphere equivalent were （ - 15.33 ±5.03）D and （ - 1.86 ± 1.41 ） D,the differences were statistically significant （ all P 〈 0.05 ）. The intraoperative partial suspensory ligament occurred in 1 eye, iris hemorrhage appeared in 1 eye when extracting the lens nucleus ;The postoperative mild corneal edema was seen in I 1 eyes, hyphema in 1 eye, temporary high IOP in 1 eye, uvei- tis in 3 eyes, which disappeared within 1 week after treatment. IOL were implanted into capsular bag except 1 eye for partly broken ciliary zonule. There was no IOL dislocation within the follow-up. Conclusion Modified large-incision manual cataract extraction combined with IOL implantation is safe and effective for high myopia with cataract.