人工晶状体巩膜内"钉帽状"袢固定术的效果观察

Observation on the efficacy of intrascleral fixation of intraocular lens with flange shaped haptics

目的:观察巩膜内"钉帽状"袢固定治疗晶状体或人工晶状体(IOL)脱位患者的临床效果。方法:回顾性研究沈阳爱尔眼视光医院2018年1月至2018年12月晶状体脱位和IOL脱位35例(35眼)的临床资料。患者均行25 G玻璃体切除术,术中烧灼IOL两袢的末端成"钉帽状"固定于巩膜隧道口,不需缝线。术后行眼前段OCT及UBM检查。结果:本研究包括晶状体脱位或不全脱位13眼及IOL脱位22眼。术后1个月及3个月的最佳矫正视力(logMAR)分别为0.43±0.35,0.37±0.22,均较术前的(1.27±0.70)显著提高(P=0.002,0.001)。IOL袢均稳固地位于巩膜隧道内,无移位。术后1个月角膜内皮细胞密度由术前(2192±558)个/mm 2减少至(1953±704)个/mm 2,差异无统计学意义(t=0.843,P=0.220)。术后并发症主要为瞳孔变形2例,玻璃体积血3例,早期低眼压2例,视网膜脱离1例。结论:25 G玻璃体切除联合IOL巩膜内"钉帽状"袢固定可有效治疗晶状体或人工晶状体脱位。

Objective To observe the clinical efficacy of intrascleral fixation of intraocular lens with flange shaped haptics for dislocated intraocular lens or subluxated crystalline lens.Methods The clinical data of 35 eyes of 35 patients with dislocated IOL or subluxated crystalline lens from Jan.2018 to Dec.2018 in Shenyang Aier Eye Hospital were retrospectively studied.All cases received 25 gauge vitrectomy.Every end of two loops of IOL was cauterized to form a flange of the haptics.The flanges of the haptics were fixed into the scleral tunnels without suture.The angle of tilt of the IOL and location of flanged haptics were assessed with ultrasound biomicroscopy(UBM)and anterior optical coherence tomography(OCT)respectively after surgery.Results There were 22 cases with dislocated IOL and 13 cases with dislocated or subluxated crystalline lens.The mean BCVA(logMAR)at 1 and 3 months after surgery improved significantly from 1.27±0.70 to 0.43±0.35 and 0.37±0.22,respectively(P=0.002,0.001).IOL loops were firmly located in the sclera tunnels without suture.The mean corneal endothelial cell density at 1 month postoperatively decreased from(2192±558)cells/mm2 to(1953±704)cells/mm2(t=0.843,P=0.220).The postoperative complications included pupil deform in 2 cases,hemorrhage in 3 cases,transient ocular hypertension in 2 cases and retinal detachment in 1 case.Conclusion 25-gauge vitrectomy combined with flange shaped haptics for intrascleral intraocular lens fixation is a simple and minimally invasive method.