无囊袋张力环下悬韧带断离IOL缝线固定术的临床体会

Observation of artificial lens implantation suture fixation into capsular bag when cataract suspensory ligament rupture without capsular tension ring

目的:探讨无囊袋张力环下白内障悬韧带断离囊袋人工晶状体(intraocular lens,IOL)植入缝线固定术的临床体会。方法:回顾分析我科2012-01/2016-12白内障悬韧带断离患者20例20眼,在无囊袋张力环下行囊袋IOL植入缝线固定术,采用悬韧带断离处囊袋赤道部穿针经过睫状沟,在角巩缘后约1.5~2.0mm原位出针,将缝线固定在IOL的上下襻后,再将IOL植入囊袋内,进行锯齿状缝合或者在事先预置好三角形巩膜瓣下进行IOL缝线固定。术后复查患者视力、眼压、前房情况和IOL位置。结果:患者20例20眼悬韧带断离无囊袋张力环下囊袋IOL植入缝线固定术后,视力均不同程度提高。术后视力≥0.8者4眼(20%),0.5~0.6者7眼(35%),0.3~0.4者8眼(40%),1眼(5%)因青光眼视神经萎缩术后视力仅为0.1。主要并发症:12眼出现角膜水肿,4眼出现瞳孔区渗出,2眼出现前房积血,均予相应处理后复查反应消失。2眼出现IOL瞳孔区少量玻璃体疝出,1眼由于玻璃体影响出现轻度IOL偏中心现象,由于视力未受明显影响未行特殊处理。随访6mo,期间无1例发生固定缝线脱落移位和IOL脱位。结论:在无囊袋张力环下采用囊袋IOL植入缝线固定术,是基层综合医院眼科可试行的一种手术方法。

AIM： To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring（CTR）. METHODS： We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens （lOLl） implantation fixation in our department from Jan. 2012 to Dec. 2016. The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera. Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the ＂Z＂ type suture, or to the beforehand prepared triangle scleral flap. The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations. RESULTS： All of the postoperative visual acuity improved different level. The postoperative best corrected visual acuity（BCVA） was /〉0.8 in 4 eyes（20%, 0.5-0.6 in7 eyes（35%）, 0.3-0.4 in 8 eyes（40%）, 0.1 in 1 eye （5%） because of the glaucoma optic atrophy. There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment. There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved. Followed up for 6mo, displaced stitches or artificial lens shift did not occur. CONCLUSION： Without CTR, the IOL implantation andsuture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.