Ⅰ期前房型与Ⅱ期巩膜固定型人工晶状体植入术在有并发症的白内障手术中的疗效比较

Clinical outcomes of anterior chamber IOL at Ⅰ stage versus sclera-fixed IOL at Ⅱ stage in complicated cataract surgeries with inadequate capsular support

目的:白内障术中发生并发症后囊膜支撑力不充分,比较Ⅰ期前房与Ⅱ期巩膜固定人工晶状体(IOL)后的临床效果。方法:对我院2003-01/2014-12期间白内障术中发生并发症后导致囊膜支撑力不充分,行Ⅰ期前房(ACIOL)或Ⅱ期经巩膜固定IOL植入术的患眼病例进行回顾分析。主要观察指标包括术后最佳矫正视力(BCVA)和术后并发症。结果:患者84眼行Ⅰ期ACIOL,79眼行Ⅱ期巩膜固定IOL。Ⅰ期ACIOL组和Ⅱ期巩膜固定IOL组术后1a BCVA(LogMAR)分别为0.30±0.64、0.33±0.34(t=0.407,P=0.712),最近一次随访的BCVA分别为0.67±0.55、0.62±0.50,差异无统计学意义(t=0.225,P=0.545)。Ⅰ期ACIOL组出现了更多的早期术后并发症,差异有统计学意义(χ~2=14.613,P<0.001);两组术后晚期并发症的发生差异无统计学意义(χ~2=0.231,P=0.267)。回归分析显示Ⅰ期ACIOL和Ⅱ期巩膜固定IOL植入术有着相似的最后一次随访BCVA(t=0.397,P=0.957),而晚期并发症的发生则与较差的最终视力预后相关(t=22.156,P<0.001)。结论:在白内障术中发生并发症导致囊膜支撑不充分时,行Ⅰ期前房(ACIOL)或Ⅱ期巩膜固定IOL植入术的患者在远期视力效果和术后并发症两方面差异无统计学意义(P>0.05)。

AIM： To compare the clinical outcome of anterior chamber intraocular lens （IOL） at Ⅰ stage versus sclera- fixed IOL at Ⅱ stage in complicated cataract surgeries with inadequate capsular support. METHODS. Complicated cataract surgeries with anterior chamber IOL （ ACIOL） or scleral- fixated IOL implantation from January 2003 to December 2014 when capsular support was inadequate were included and analyzed. Postoperative bestcorrected visual acuity （BCVA） were compared. Postoperative complications were recorded and analyzed.RESULTS： Totally 84 eyes and 79 eyes were included in the ACIOL group and in the scleral-fixated IOL group, respectively. The mean postoperative logarithm of minimal angle of resolution （LogMAR） BCVA at la was 0.30±0.64 and 0.33±0.34 in the ACIOL group and the scleral- fixated IOL group, respectively （ t = 0. 407, P= 0. 712）. The mean latest LogMAR BCVA was 0.67±0.55 and 0. 62 ±0. 50 in the primary ACIOL group and the secondary scieral-fixated IOL group, respectively （t= 0, 225, P= 0,545）. There were more early postoperative complications in the ACIOL group （X2 = 14. 613, P〈0. 001 ）.No difference in late postoperative complications was found between the two groups （X2 = 0, 231, P= 0,267）, Regression analysis suggested that ACIOL and scleralfixated IOL implantation had similar latest postoperative LogMAR BCVA （t= 0, 397, P= 0. 957）; however the existence of late complications were related with a worse final visual outcome （ t= 22. 156, P〈0. 001 ）. CONCLUSION. The long-term differences in the visual outcomes and complication profiles after ACIOL atⅠ stage or scleral-fixated IOL implantation at Ⅱ stage in a complicated cataract operation are not found when capsular support is inadequate.