反向巩膜隧道法人工晶状体悬吊术的长期疗效及安全性分析

Long-term efficacy and safety of transscleral suture fixation of intraocular lens with a reverse scleral tunnel

目的总结反向巩膜隧道法用于人工晶状体悬吊术的长期有效性和安全性。设计回顾性病例系列。研究对象北京协和医院眼科2016-2017年行反向巩膜隧道法人工晶状体悬吊术的患者11例(14眼)。方法手术中无需剪开球结膜,自角巩膜缘向穹窿方向做2.5 mm宽、3.0 mm长的反向巩膜隧道,将悬吊线套于人工晶状体环形襻,并埋藏固定于反向巩膜隧道内。平均随访时间(29.4±2.3)个月。主要指标术前及术后裸眼视力、最佳矫正视力,术后人工晶状体位置,以及线结暴露、慢性充血、感染性眼内炎、人工晶状体移位等术后并发症。结果术后末次随访裸眼视力(LogMAR)为0.40±0.35较术前(1.28±0.42)改善(P<0.001),术后末次随访最佳矫正视力(LogMAR)为0.24±0.31较术前(0.74±0.35)改善(P<0.001)。所有患者随访期内人工晶状体位置平正、无倾斜,未报告线结暴露、慢性充血、感染性眼内炎、人工晶状体移位等并发症。结论反向巩膜隧道法改良人工晶状体悬吊术是一种微创、有效、安全的手术方法。

Objective To evaluate the long-term efficacy and safety of the reverse scleral tunnel method in transscleral suture fixation of intraocular lens(IOL).Design Retrospective case series.Participants Fourteen eyes of 11 patients undergoing transscleral suture fixation of IOL with reverse scleral tunnel method between January 2016 and December 2017 in Peking Union Medical College Hospital.Methods The core techniques of surgery was making a reverse scleral tunnel from corneal limbus to conjunctival fornix which was 2.5 mm in width and 3.0 mm in length.The intrascleral suture was buried in the reverse scleral tunnel.Mean follow-up duration was 29.4±2.3 months.Main Outcome Measures Preoperative and postoperative uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA),long-term stability of IOL position and postoperative complications.Results UCVA(LogMAR)improved from 1.28±0.42 at baseline to 0.40±0.35 at last visit(P<0.001).BCVA(LogMAR)improved from 0.74±0.35 at baseline to 0.24±0.31 at last visit(P<0.001).In the follow-up period,the IOL position remained stable in all subjects.There were no postoperative complications such as suture knot exposure,chronic conjunctival hyperemia,infectious endophthalmitis,and IOL dislocation.Conclusion The reverse scleral tunnel method is a long-term effective and safe method in transscleral suture fixation of intraocular lens.