外伤性晶状体脱位不同手术方式的疗效

The efficacy of different methodes of surgery for traumatic luxation of lens

目的观察外伤性晶状体脱位不同手术方式的临床治疗效果。方法外伤性晶状体脱位35例（39眼），其中晶状体不全脱位16例（18眼），晶状体全脱位19例（21眼），均伴有视网膜脱离、玻璃体浑浊或继发性青光眼。对于晶状体不全脱位，脱位范围≥180°且无视网膜脱离者进行三通道玻璃体手术行晶状体切除联合玻璃体切除术，I期睫状沟缝线固定人工晶状体植入术；不全脱位范围〈180°者进行晶状体超声乳化吸出人工晶状体植入术。对于晶状体全脱位，则行晶状体囊内摘出术。随访观察其效果。结果全部35例（39眼）均顺利完成手术，术前眼压（32．5±3．7）mmHg，其中〉21mmHg者28例；视力（logMAR）1．4±0．2。术后1个月眼压（17．3±2．6）mmHg，〉21mmHg者4例；视力（10gMAR）0．2±0．1；手术前后眼压及视力比较差异均有统计学意义（P〈0．05）。术后随访3～6个月，未见明显并发症发生。结论对外伤性晶状体脱位患者采取针对性的手术方法有助于降低眼压，促进视力恢复。

Objective To observe clinical efficacy of different surgical treatment for traumatic luxation of lens. Methods The data of 39 eyes of 35 cases with traumatic luxation of lens were selected, including lens subluxation 18 eyes of 16 cases, lens complete dislocation 21 eyes of 19 cases. Some cases combined with retinal detachment, vitreous opacity or secondary glaucoma. For the patients with subluxation of lens and the dislocation range ≥ 180°, without retinal detachment, received three channel vitrectomy and lensectomy, combinded with ciliary sulcus suture fixation of intraocular lens implantation. Phacoemulsification and intraocular lens implantation were performed in paitents with the incomplete dislocation range 〈 180°. For the patients with complete dislocation of the lens, the intracapsular extraction were performed. During the following period, the clinical treatment efficacy was observed. Results All patients underwent operation successfully. The intraocular pressure was （32. 5 ± 3.7） mmHg before surgery, 〉 21 mmHg in 28 cases. The visual acuity was 1.4 ± 0. 2 （logMAR） in preoperative. One month after surgery, the IOP was （ 17.3 ±2.6 ） mmHg and the visual acuity was （ 0.2 ±0. 1 ）, IOP 〉 21 mmHg in 4 cases. The difference in intraocular pressure and visual acuity were statistically sinificant （ P 〈 0. 05 ）. Followed up for 3-6 months, no obvious complication happened. Conclusion Targeted surgical treatment for traumatic luxation of lens is helpful to reduce the intraocular pressure, and improve visual acuity.