玻璃体切割术后IOL混浊病例的临床与实验研究

Clinical and Experimental Study of Intraocular Lens Opacity after Pars Plana Vitrectomy

目的:探讨玻璃体切割术(PPV)后人工晶状体(IOL)混浊的病例特点及相关危险因素。方法:回顾性研究。连续纳入2007年2月至2022年2月在山东第一医科大学附属青岛眼科医院发现的全部PPV术后出现IOL混浊的病例资料11例,选取其中2枚取出且保存良好的IOL进行体外光镜、扫描电镜、激光共聚焦显微镜检测以及能谱分析。结果:11例患者年龄为23~76(63.3±15.0)岁,发现IOL混浊与PPV间隔时间为24~180(82.2±45.7)个月。11例患者中8例有视网膜光凝史,5例有眼内硅油/气体注入手术史,1例有青光眼手术史。11例患者中糖尿病6例,高血压5例。患者所用IOL类型及临床处置情况分别为:9例(9/11)为亲水性丙烯酸酯,型号分别为860UV(1例,已取出)、Akreos Adapt AO(2例,已取出1例)和具有疏水涂层的亲水性L-312(6例,已取出4例);另外2例(2/11)为疏水性丙烯酸酯MA60MA(未取出)。2枚混浊的IOL检测情况如下:第1枚是860UV型IOL,混浊部位主要集中于光学部前表面,光镜及扫描电镜下呈弥漫、凹凸不平蚯蚓状、地嵴状,襻部及周边未见明显沉积物;激光共聚焦显微镜显示混浊主要集中在前浅层,深度大约为IOL整体厚度的前6.9%;能谱分析显示,按元素组成比例高低排列为碳、氧、钙、磷、硅和镁元素。第2枚是Akreos Adapt AO型IOL,混浊主要处于光学区中央,光镜及扫描电镜下呈粗糙、小圆形的砂粒,襻部也散在累及,呈较为致密的砂粒状;共聚焦显微镜显示混浊区域更深,大约为IOL整体厚度的前12.5%;能谱分析显示,按元素组成比例高低排列为碳、氧和硅元素。结论:PPV后不同类型丙烯酸酯IOL均有可能发生混浊,且IOL混浊的形态和表面沉积物各不相同。

Objective:To investigate the case characteristics and risk factors for intraocular lens(IOL)opacities after pars plana vitrectomy(PPV).Methods:In this retrospective study,two of the retrieved and well preserved IOLs were chosen for experimental studies including in vitro light microscopy,scanning electron microscopy,laser confocal microscopy,and energy dispersive spectrometer analysis to evaluate the case data of 11 patients who developed IOL opacities after PPV surgery at Qingdao Eye Hospital of Shandong First Medical University from February 2007 to February 2022.Results:The age of the 11 patients ranged from 63.3±15.0(23 to 76)years,and the duration between IOL opacity and PPV was assessed to be 82.2±45.7(24 to 180)months.Eight patients underwent retinal photocoagulation,five had intraocular silicone oil/gas injection surgery,and one had glaucoma surgery.Six cases of diabetes and five cases of hypertension were identified as systemic diseases.The patients'IOLs and clinical disposition were as follows:hydrophilic acrylates in 9 instances(9/11),including type 860UV(1 case,removed),Akreos Adapt AO(2 cases,1 removed),and hydrophilic acrylic material with a hydrophobic surface coating L-312(6 cases,4 removed);and hydrophobic acrylate MA60MA in the other two cases(2/11,not removed).The study revealed two opacities IOLs:the first was an 860UV type IOL with the opacities component primarily positioned on the optical section's front surface.It was diffuse,uneven,earthworm-shaped,and ridge-shaped under the light microscope and scanning electron microscopy,with no obvious sediment at the loop and around;laser confocal microscopy revealed that the opacities were primarily concentrated in the anterior superficial layer,with a depth of approximately anterior 6.9%of the overall thickness of the IOL.Energy dispersive spectrometer examination showed that carbon,oxygen,calcium,phosphorus,silicon,and magnesium were arranged according to the amount of content;The second was an Akreos Adapt AO type IOL,which had opacities principally in the optical zone,under light microscopy and scanning electron microscopy,coarse,microscopic spherical sand grains,as well as sand grains in the loop and peripheral areas.Laser confocal microscopy showed that the opacities were deeper,at about Anterior 12.5% of the total thickness of the IOL.Energy dispersive spectrometer examination showed that carbon,oxygen,and silicon were arranged according to the amount of content.Conclusion:Opacities can occur with different types of acrylate IOLs following PPV,and the shape and surface deposits of IOL opacities vary.