伴有高度近视眼晚期自发性人工晶状体囊袋复合体脱位的临床观察

Clinical analysis of late spontaneous intraocular lens-capsular bag complex dislocation in high myopia

目的探讨高度近视眼白内障术后晚期自发性人工晶状体囊袋复合体脱位的发病机制、临床特点、治疗方法及预后。方法纳入北京同仁医院2006年9月—2017年9月收治高度近视眼白内障术后晚期自发性人工晶状体囊袋复合体脱位患者15例(15只眼)进行回顾性研究。观察发病时间、诱发因素、术前眼部情况、治疗方法等。结果(1)基本情况:15例患者中,男6例,女9例,男女比例为2:3;左眼10只,右眼5只,左右眼比例为2:1;年龄39~73岁,平均(57.00±9.19)岁;眼轴长度为26.22~34.81 mm,平均(29.76±2.76)mm;自发性人工晶状体囊袋复合体脱位发生时间最短为术后1年,最长为术后11年,平均(5.40±3.03)年。(2)伴随情况:糖尿病患者4例(26.67%),高血压患者6例(40.00%),另外5例无全身系统疾病(33.33%)。(3)诱发因素:1例有持重物史(6.67%),其余14例中发病均无明显诱发因素(93.33%)。(4)术前情况:矫正视力为眼前指数~0.4;平均眼压为13.6 mm Hg。(5)治疗方法:除3例患者因自身原因未手术外(20.00%),12例均行手术治疗。2例行玻璃体切除联合人工晶状体取出术(13.30%),未悬吊人工晶状体;6例行玻璃体切除联合原人工晶状体悬吊术(40.00%);4例行玻璃体切除联合人工晶状体取出及眼内光凝术,未悬吊人工晶状体(26.70%)。(6)术后情况:术后恢复较好,无并发症出现。结论高度近视眼白内障术后晚期自发性人工晶状体囊袋复合体脱位与晶状体悬韧带断裂和晶状体囊袋收缩关系密切。手术积极处理可挽救一定视力。

OBJECTIVE To investigate the pathogenesis,clinical features,treatment and prognosis of late spontaneous intraocular lens capsular complex dislocation after cataract surgery in high myopia.METHODS Fifteen patients(15 eyes)with advanced intraocular lens capsular complex dislocation after cataract surgery in high myopia were enrolled in Beijing Tongren Hospital from September 2006 to September 2017 for a retrospective study.The time of onset,predisposing factors,preoperative eye conditions,there were treatment methods were observed.RESULTS(1)Basic information:Among the 15 patients,6 males and 9 females and the ratio of male to female was 2:3;there were 10 left eyes and 5 right eyes and the ratio of left and right eyes was 2:1;age was 39 to 73 years old,and average was 57.00±9.19 years old;The length of the eye axis was 26.22~34.81mm,and the average eye axis length was 29.76 spontaneous intraocular lens capsular complex dislocation occurred at the shortest 1 year postoperatively,and the longest was postoperative 11 years,and average was 5.40±3.03 years.Concomitant circumstances:4 of them were diabetic patients,6 were hypertensive patients,and the other 5 had no systemic diseases.(3)Predisposing factors:1 case had a history of holding heavy objects(6.67%),and there was no obvious predisposing factor(93.33%)in the other 14 cases.(4)Preoperative condition:corrected vision was anterior index~0.4;average intraocular pressure was 13.6 mmHg.(5)Treatment method:Except for 3 patients who did not undergo surgery due to their own reasons(20.00%),other 12 patients underwent surgery.Among them,2 cases underwent vitrectomy combined with intraocular lens removal(13.30%)without IOL suspension;6 cases underwent vitrectomy combined with original intraocular lens suspension(40.00%);4 cases underwent vitrectomy combined with intraocular lens removal and intraocular photocoagulation without intraocular lens suspension(26.70%).(6)Postoperative situation:The postoperative recovery was good,and no complications occurred.CONCLUSIONS Late spontaneous intraocular lens capsular complex dislocation after cataract surgery in high myopia was closely related to the rupture of the lens suspensory ligament and lens capsular contraction.Active treatment of surgery could save vision to certain extent.