反向巩膜袋法人工晶状体固定术临床观察

Clinical observation on suture fixation of intraocular lens with reverse scleral pocket

目的观察反向巩膜袋法人工晶状体固定术的临床效果。方法回顾性分析黄河中心医院2017年3月至2019年3月共31例(31眼)无完整后囊的无晶状体眼的临床资料,所有患者均采用反向巩膜隧道形成结膜巩膜袋复合体,睫状沟缝合固定人工晶状体,术后随访6~12个月,观察手术后视力、角膜内皮细胞密度、泪膜破裂时间、Schirmer I试验及眼压。结果随访期末,所有患眼裸眼视力、最佳矫正视力均较术前提高,差异有统计学意义(t=12.119、16.001,P<0.05)。所有患眼泪膜破裂时间、Schirmer I试验、角膜内皮细胞密度及眼压与术前相比,差异均无统计学意义(P>0.05)。术后2周裸眼视力≥0.5者29例,占93.5%。术后人工晶状体位正、无倾斜,未出现缝线暴露,未出现脉络膜脱离、视网膜脱离或爆发性脉络膜出血等严重的并发症。结论反向巩膜袋人工晶状体固定术治疗无完整后囊的人工晶状体眼安全有效。

Objective To observe the clinical efficacy of suture fixation of intraocular lens with reverse scleral pocket.Methods The clinical data of 31 eyes of 31 cases of aphakia without intact posterior capsule from Mar.2017 to Mar.2019 in Huanghe Central Hospital were analyzed retrospectively.All cases received reverse scleral tunnel used to form the conjunctival-scleral pocket complex,fixed one-piece soft foldable intraocular lens in the ciliary sulcus.All cases were follow-up for 6-12 months after operation.The visual acuity,corneal endothelial cell density,tear film break-up time,Schirmer I test and IOP after operation were observed.Results At the end of the follow-up time,the uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA)were improved.The differences in UCVA and BCVA were statistically significant before and after operation(t=12.119,16.001;P<0.05).There was no significant difference in tear break-up time,schirmerⅠtest,the corneal endothelial cell density or intraocular pressure before and after the operation(P>0.05).There were 29 cases with UCVA≥0.5 at 2 weeks after operation,accounted for 93.5%.The postoperative intraocular lens position of the patient was normal,without tilt,and no sutures were exposed.No serious complication such as choroidal detachment,retinal detachment or fulminant choroidal hemorrhage occurred.Conclusion One piece foldable intraocular lens fixation with reverse scleral pocket is safe and effective for the treatment of aphakia without intact posterior capsule.