白内障伴晶状体不全脱位两种术式的临床效果对比

Comparison on the efficacy of two methods of surgery for cataract accompanied with subluxation of lens

目的 比较白内障伴晶状体不全脱位两种手术方式的临床效果.方法 回顾性分析2013年7月至2017年7月白内障伴晶状体不全脱位44例（53眼）.患者随机分为两组：A组,20例（25眼）行IOL囊袋内单襻缝线固定术;B组,24例（28眼）行联合前段玻切及IOL睫状沟悬吊术,术后随访1-24个月.结果 A组术后BCVA （LogMAR）为0.71 ±0.14;8眼（32.0％）低眼压;1眼（4.1％）高眼压;18眼（72.0％）后发性白内障;术后3d8眼（32.0％）出现不同程度术后反应.B组术后BCVA为0.60±0.13;17眼（60.7％）低眼压;1眼（3.6％）高眼压;术后3 d20眼（71.4％）出现不同程度术后反应.术后BCVA,B组优于A组,差异有统计学意义（t=3.006,P=0.004）;术后低眼压发生率比较,B组高于A组（χ^2=4.370,P=0.037）;术后高眼压发生率两组差异无统计学意义（χ^2=0.007,P=0.935）;术后反应发生率比较,B组高于A组（χ^2=8.239,P=0.004）.结论 白内障伴晶状体不全脱位的两种手术方法均能有效改善患者视力.术后早期,B组视力较好;A组低眼压发生率低、IOL稳定性好、术后炎症反应少.

Objective To compare the efficacy of two methods of surgery for cataract accompanied with subluxation of lens.Methods The data of 53 eyes of 44 cases with cataract accompanied with subluxation of lens from Jul.2013 to Jul.2017 were retrospectively analyzed.All cases were randomly divided into two groups.Group A,phacoemulsification combined with the single loop of capsular IOL suture fixation （Phaco ＋ IOLSF） were performed in 25 eyes of 20 cases.Group B,pars plana lensectomy and vitrectomy combined with ciliary sulcus-sutured IOL implantation（PPL ＋ PPV ＋ IOL）were performed in 28 eyes of 24 cases.The follow-up time was 1-24 months.Results The postoperative BCVA（Log MAR） was 0.71 ±0.14 in group A and 0.60 ±0.13 in group B.The low IOP after surgery occurred in 8 eyes（32.0%） in group A and 17 eyes （60.7%） in group B.The IOP elevation occurred in 1 eye（4.1%） in group A and 1 eye（3.6%） in group B.The posterior capsular opacification （PCO） occurred in 18 eyes（72.0%） in group A.The reaction at 3 days postoperatively occurred in 8 eyes （32.0%） in group A and 20 eyes （71.4%） in group B.BCVA of group B was better than that of group A and the difference was statistically significant （t =3.006,P =0.004）.The incidence of the low IOP after surgery in group B was higher than that of group A （χ^2 =4.370,P =0.037）.The incidence of the IOP elevation in group B was lower than that of group A （χ^2 =0.007,P =0.935）.The incidence of the reaction postoperatively in group B was higher than that of group A （χ^2 =8.239,P =0.004）.Conclusion Visual acuity can be improved with two surgical methods for subluxation of lens.Postoperative early stage,BCVA of group B is better.The incidence of low IOP of group A is lower and the IOL location is stable.