人工晶状体预先巩膜悬吊在严重晶状体半脱位中的应用

The effect of intraocular lens(IOL)pre-suspension in the treatment of severe lens subluxation

目的:探讨人工晶状体(IOL)预先巩膜悬吊在严重晶状体半脱位中的应用效果。方法:选取2018年12月至2022年7月四川省人民医院收治的>180°的严重晶状体半脱位患者8例(8眼)。术中避开脱位的晶状体,预先将IOL悬吊于玻璃体腔,再将晶状体托起置于IOL上方,必要时辅助以虹膜拉钩,稳定晶状体,确保超声乳化手术安全完成。结果:严重的晶状体半脱位患者8例,其中晶状体核N1-N3硬度的患者各1例,单独使用IOL预先巩膜悬吊于术中稳定脱位的晶状体,3例超声乳化手术均顺利完成;达N4患者3例、N5患者2例,其中4例在虹膜拉钩的辅助下安全完成超声乳化;有1例N5的患者,由于悬韧带损伤超过270°,在将晶状体托起放置于IOL之上时,坠入玻璃体腔,给予玻璃体腔超声粉碎处理。8例患者术后IOL均居中,视力有不同程度的提高,眼压正常,未见严重并发症。结论:在严重晶状体半脱位的超声乳化手术中,对于N2~N3的软核,IOL预先巩膜悬吊可以良好地稳定晶状体,确保超声乳化手术的顺利进行;对于N4~N5的硬核,IOL预先巩膜悬吊可以作为一种辅助方法,联合虹膜拉钩共同稳定晶状体,确保超声乳化手术的安全进行。

Objective:To investigate the effect of intraocular lens(IOL)pre-suspension in thetreatment of severe lens subluxation.Methods:Retrospective case study.From December 2018 to July 2022,8 eyes of 8patients with severe lens subluxation greater than 180 degrees admitted to our hospital were selected.During surgery,the IOL should avoid the subluxated lens and be pre-suspended in the vitreous cavity,and then the lens is lifted and placed above the IOL.If necessary,the iris hook can be used to stabilize the lens to ensure the safe completion of phacoemulsification.Results:There were 8 patients with severe subluxation of lens.Among them,the hardness of 3 patients’lens nucleus ranged from N1 to N3.In these3 patients,we used the IOL pre-suspension alone to stabilize the subluxated lens,and phacoemulsification in these 3 patients was successfully completed.Three patients had N4 and 2 patients had N5,of which4 patients underwent phacoemulsification safely with the assistance of iris hook.In another patient with N5,the lens fell into the vitreous cavity during surgery(the suspension ligament rapture greater than 270 degrees)when it was lifted and placed on the IOL which was crushed by the vitreous cavity ultrasound.After surgery,the IOL was centered in all 8 patients,visual acuity was improved to varying degrees,intraocular pressure was normal,and no serious complications were observed.Conclusions:In severe lens subluxation surgery,IOL presuspension in soft nuclei of N2 to N3 can stabilize the lens well and ensure the safety of phacoemulsification.For hard nuclei N4 to N5,IOL presuspension can be used as an auxiliary method in combination with iris hook to stabilize the lens and ensure the safety of phacoemulsification.