超声乳化晶状体摘除联合人工晶状体植入治疗马凡综合征晶状体半脱位的长期观察

Long-term clinical effect observation of phacoemulsification and intraocular lens implantation for patients with lens subluxation secondary to Marfan syndrome

目的观察超声乳化晶状体摘除联合人工晶状体植入治疗马凡综合征晶状体半脱位的长期疗效及安全性。方法回顾分析2009年至2018年手术的马凡综合征晶状体半脱位患者9例(17只眼),采用超声乳化吸除晶状体,必要时摘除囊袋、切除前部玻璃体,张力环辅助囊袋内植入人工晶状体或行人工晶状体缝线固定。术后配镜,必要时弱视训练。观察术前术后的裸眼视力、最佳矫正视力,并评估并发症。结果全部患者无术中并发症。术后末次随访裸眼视力(0.22±0.22(LogMAR))较术前(1.07±0.22(LogMAR))提高(P<0.01)。术后末次随访最佳矫正视力(0.22±0.19(LogMAR))较术前(0.82±0.12(LogMAR))提高(P<0.01)。1例(1只眼)张力环辅助植入人工晶状体者术后2周人工晶状体移位,予缝线固定,随诊2年位置稳定,其余患者无人工晶状体移位。随访期内无线结暴露、青光眼、感染性眼内炎、视网膜脱离等并发症。结论超声乳化晶状体摘除联合人工晶状体植入治疗马凡综合征晶状体半脱位宜采取个性化手术设计,总体效果良好,远期安全稳定。

Objective To evaluate the long-term efficacy and safety of phacoemulsification and intraocular lens(IOL)implantation for patients with lens subluxation secondary to Marfan syndrome.Methods This retrospective study included 9 patients(17 eyes)who underwent phacoemulsification and IOL implantation for lens subluxation secondary to Marfan syndrome from 2009 to 2018.Capsule removal and anterior vitrectomy were performed if needed.IOL was implanted with a capsular tension ring or transscleral suture.Postoperative refraction correction and amblyopia training were performed.Intraoperative and postoperative surgical complications were also recorded.Results All surgeries were uneventful without intraoperative complications.Uncorrected visual acuity and best-corrected visual acuity(BCVA)improved from 1.07±0.22 and 0.82±0.12 before the surgery to 0.22±0.22 and 0.22±0.19 at last visit,respectively(P<0.01).One eye developed intraocular lens subluxation at 2 weeks after capsular tension ring assisted IOL implantation.Scleral suture of IOL was performed subsequently and IOL position remained stable for the following 2 years.IOL subluxation and other complications were not observed in other patients.Surgical complications,including suture exposure,glaucoma,infectious intraocular inflammation and retinal detachment,were not observed.Conclusions Individualized surgical procedures should be performed in phacoemulsification and IOL implantation for lens subluxation secondary to Marfan syndrome to achieve long-term effectiveness and safety.