无线结Z缝合人工晶状体巩膜固定术治疗囊袋/悬韧带支撑力不足的效果观察

Efficacy of scleral fixated intraocular lens implantation with knotless Z-suture technique for inadequate capsule/zonular support

目的观察采用无线结Z缝合人工晶状体巩膜固定术治疗晶状体囊袋/悬韧带支撑力中重度不足患者的效果。设计回顾性病例系列。研究对象2017年7月至2021年1月在北京同仁医院眼外伤科因中重度囊袋/悬韧带支持不足(晶状体悬韧带松弛或断裂超过6个钟点或残余晶状体囊袋无法支撑人工晶状体睫状沟植入)采用无线结Z缝合人工晶状体巩膜固定术治疗的患者78例(88眼)。方法所有患者均接受包含无线结Z缝合人工晶状体巩膜固定术的标准程序手术,随访时间中位数19个月(12~50个月,15~25.5个月)。观察手术前后视力、手术并发症、术后人工晶状体位置等。主要指标裸眼视力、最佳矫正视力(BCVA)、手术并发症、人工晶状体位置。结果术前裸眼视力为眼前手动~0.4,术后6个月裸眼视力为0.04~1.0,均较术前有不同程度提高,其中术后6个月裸眼视力≥0.3者有80眼(90.9%)。末次随访时平均BCVA(0.20±0.15)明显高于术前(0.79±0.36)(t=-9.783,P<0.001)。至末次随访,未出现缝线处伤口渗漏、巩膜薄变、巩膜融解、慢性炎症、缝线侵蚀、缝线暴露及眼内炎等缝线相关并发症,Z字走行的悬吊缝线在裂隙灯显微镜下均不可见。需要有创干预的并发症有视网膜脱离1眼(1.1%)和人工晶状体夹持1眼(1.1%),均为马凡综合征患儿。其余患者在散大瞳孔的裂隙灯显微镜下检查IOL稳定性良好,未见明显的IOL震颤、脱位、偏位或倾斜,未见黄斑囊样水肿、角膜内皮失代偿、继发性青光眼、爆发性脉络膜上腔出血等严重并发症。结论无线结Z缝合技术可用于晶状体囊袋/悬韧带支撑力中重度不足患者的治疗,在保证较好疗效的基础上可减少缝线相关并发症。(眼科,2022,31:207-212)

Objective To observe the efficacy of the scleral fixated intraocular lens implantation with knotless Z-suture technique for moderate severe inadequate capsule/zonular support.Design Retrospective case series.Participants Eighty-eight eyes of 78 Moderate to severe inadequate capsule/zonular support patients,who were cases with over 180°zonular weakness or residual capsule inadequate to support intraocular lens ciliary groove implantation,were included from July 2017 to January 2021 in Ocular Trauma Department of Beijing Tongren Hospital.Methods All patients underwent surgeries including the standard procedure of scleral fixated intraocular lens implantation with knotless Z-suture technique.The median follow-up duration was 19 months(range 12~50,quartile 15~25.5 months).Preoperative and postoperative visual acuity,complications,intraocular lens position were observed.Main Outcome Measures Uncorrected visual acuity,best corrected visual acuity(BCVA),complications,and intraocular lens position.Results The uncorrected visual acuity was hand motions~0.4 at baseline.It improved to 0.04~1.0 at 6th month follow-up including 80 eyes(90.9%)≥0.3.The BCVA improved significantly from 0.79±0.36 at baseline to 0.20±0.15 at last follow-up(t=-9.783,P<0.001).No suture-related complications such as wound leakage at the sutures,sclera thinning,sclera melting,chronic inflammation around the suture,suture erosion,suture exposure,and endophthalmitis was observed in any cases.The Z-sutures were invisible in all cases under the slit lamp microscopy.Complications requiring invasive treatment were retinal detachment in 1 eye(1.1%)and intraocular lens pupillary capture in 1 eye(1.1%).Both cases were children with Marfan syndrome.All the other intraocular lens were in the expected position without obvious pseudophakodonesis,dislocation,decentration or tilt.No cystoid macular edema,corneal endothelial decompensation,secondary glaucoma,suprachoroidal hemorrhage or endophthalmitis was observed.Conclusion Knotless Z-suture technique can effectively reduce the occurrence of suture-related complications which is applicable for various cases of moderate to severe inadequate capsule/zonular support.(Ophthalmol CHN,2022,31:207-212)