复杂真性小眼球白内障手术治疗2例

Surgical treatment of 2 cases of complex nanophthalmic eyes with cataract

病例一:72岁男性,因“双眼视力下降3年,右眼显著”就诊。患者自幼双眼视力不佳,10年前曾行双眼“抗青光眼手术”,具体手术方式不详。双眼裸眼视力:右眼HM/BE,左眼FC/20 cm。最佳矫正视力:右眼0.02(+18.0 DS),左眼0.12(+18.0 DS)。裂隙灯检查示双眼前房极浅,双眼晶状体核性混浊。眼B超提示双眼小眼球可能,双眼颞下周边视网膜脱离可能。眼轴:右眼16.21 mm,左眼16.31 mm。诊断:双眼并发性白内障,双眼真性小眼球。予以全身麻醉下右眼Phaco+人工晶状体(IOL)植入+巩膜瓣下巩膜切除术,术中植入40.0 D IOL一枚。手术顺利,无并发症。病例二:59岁男性,因“右眼视力下降2年”就诊。患者自幼双眼视力不佳,双眼曾因葡萄膜渗漏综合征先后行巩膜板层切除术。双眼裸眼视力:右眼HM/BE,左眼FC/20 cm。最佳矫正视力:右眼0.01(+18.5 DS),左眼0.2(+17.00 DS/-0.75 DC×85°)。裂隙灯检查示双眼前房极浅,双眼晶状体核性混浊。双眼后极视网膜平伏。眼B超提示双眼小眼球,球壁增厚。眼轴:右眼15.40 mm,左眼15.51 mm。诊断:双眼并发性白内障,双眼真性小眼球。予以全身麻醉下右眼Phaco+IOL植入+深板层巩膜切除术,术中植入40.0 D IOL一枚。手术顺利,无并发症。讨论体会:在为有眼部手术史的真性小眼球患者行白内障手术时,应根据患者具体情况有针对性地设计手术方案,必要时可预防性行巩膜切除/切开术,以预防葡萄膜渗漏的发生。同时在IOL选择方面,谨慎选择Piggyback IOL,安全恢复视功能更重要。

Case 1:A 72-year-old male presented with a complaint of"decline in visual acuity in both eyes for 3 years,with the right eye being more severe".The patient has had poor vision in both eyes since childhood and underwent bilateral surgical treatment for glaucoma 10 years ago,with no details on the specific surgical procedure.The uncorrected distance visual acuity(UDVA)was hand motion(HM)in the right eye(OD)and finger counting(FC)at 20 cm in the left eye(OS).Best corrected visual acuity(BCVA)was 0.02(+18.0 DS)OD and 0.12(+18.0 DS)OS.Slit-lamp examination showed extremely shallow anterior chambers and nuclear cataracts in both eyes.B-scan ultrasonography suggested the possibility of microphthalmos in both eyes and peripheral retinal detachment in the inferotemporal quadrant of both eyes.Axial lengths(AL)were 16.21 mm OD and 16.31 mm OS.The diagnosis was bilateral nanophthalmos with cataract.The patient underwent general anesthesia for right eye phacoemulsification with intraocular lens(IOL)implantation and sclerostomy.A 40.0 D intraocular IOL was implanted.The surgery went smoothly without complications.Case 2:A 59-year-old male sought treatment for"a 2-year decline in vision in the right eye".The patient had poor vision in both eyes since childhood and had undergone sclerectomy for uveal effusion syndrome.The UDVA was hand motion(HM)OD and finger counting(FC)at 20 cm OS.BCVA was 0.01(+18.5 DS)OD and 0.2(+17.00 DS/-0.75 DC×85°)OS.Slit-lamp examination showed extremely shallow anterior chambers and nuclear cataracts bilaterally.The retina appeared flat at the posterior pole in both eyes.B-scan ultrasonography suggested microphthalmos in both eyes with thickened sclera.AL were 15.40 mm OD and 15.51 mm OS.The diagnosis was bilateral nanophthalmos with cataract.The patient underwent general anesthesia for right eye phacoemulsification with a 40.0 D IOL implantation and deep sclerectomy.The surgery was successful without complications.When performing cataract surgery on patients with nanophthalmos and a history of eye surgery,it is necessary to design a customized surgical plan.If necessary,prophylactic sclerectomy was recommended to prevent the occurrence of choroidal effusion.At the same time,regarding the selection of IOLs,the choice of Piggyback IOL should be made with caution,as the safe restoration of visual function is more important.