人工晶状体置换术的疗效观察

Observation on therapeutic effect of intraocular lens exchange surgery

目的 探讨临床行人工晶状体置换术的原因、手术原则和效果。方法 回顾性分析 30例 (30只眼 )患者行人工晶状体置换术的原因 ,总结手术方法 ,并观察手术疗效。随访时间 1～ 2 4个月。结果 行人工晶状体置换术的原因为人工晶状体偏中心或脱位 11例 (36 7% ) ,人工晶状体混浊8例 (2 6 7% ) ,人工晶状体屈光度数错误 8例 (2 6 7% ) ,人工晶状体虹膜夹持 3例 (10 0 % )。手术置换人工晶状体的方法包括晶状体囊袋内植入 11例 (36 7% ) ,睫状沟固定 13例 (43 3% ) ,巩膜缝线固定5例 (16 7% ) ,植入前房型人工晶状体 1例 (3 3% )。术后最佳矫正视力≥ 0 5者 2 3例 (76 7% ) ,0 3～ 0 4者 5例 (16 7% ) ,<0 2者 2例 (6 6 % )。术后并发症包括术眼散光 4例 ,黄斑囊样水肿 2例 ,前房出血 1例 ,晶状体后囊膜混浊 1例。结论 人工晶状体偏中心或脱位、混浊和度数错误是行人工晶状体置换术的主要原因 ;正确选择人工晶状体并掌握操作技巧可减少白内障摘除人工晶状体植入术后人工晶状体异常情况发生 ;

Objective To explore the causes, surgical principle and effect of lens exchange surgery Methods The causes for 30 cases (30 eyes) of lens exchange were retrospectively analyzed, which included 11 cases with eccentric or dislocated intraocular lens (IOL, 36 7%),8 cases with lens opacification (26 7%), 8 cases with incorrect power (26 7%) and 3 cases with iris capture (10 0%) There were 16 males and 14 females aged 32 to 80 years (average, 62) Results After extraction of the original implant, the second IOL was inserted in the lens bag in 11 cases (36 7%), in the ciliary sulcus in 13 cases (43 3%), in the anterior chamber in 1 case (3 3%) and with scleral fixation in 5 cases (16 7%) In the follow up of 1-24 months, the best corrected visual acuity over 0 5 was achieved in 23 cases (76 7%), 0 3-0 4 in 5 cases (16 7%), under 0 2 in 2 cases (6 6%) The surgical complications included astigmatism in 4 cases, cystoid macular edema 1 case, hyphema 1 case and posterior capsular opacification 1 case Conclusions The eccentric or dislocated IOL, lens opacification and incorrect power are the major causes of lens exchange Proper IOL selected and meticulous operative technique can avoid the abnormality of IOL, and the lens exchange is an effective way to manage the situation