Efficacy of scleral-fixated 3-looped haptics intraocular lens implantation for surgical management of microspherophakia

AIM:To evaluate the safety and efficacy of scleral-fixated 3-looped haptics intraocular lens(IOL)implantation for surgical management of microspherophakia.METHODS:A retrospective case series include 10 microspherophakic patients(15 eyes)who underwent lens removal plus a modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation.The primary outcomes involved visual acuity,intraocular pressure(IOP).Secondary outcomes were spherical equivalent(SE),anterior chamber depth(ACD),corneal endothelial cell density and postoperative complications.RESULTS:After a postoperative follow-up of 17.60±15.44mo,improved visual outcomes can be observed.The uncorrected distance visual acuity(UCVA)log MAR improved from 1.54±0.59 preoperatively to 0.51±0.35 postoperatively(P=0.001),and best corrected visual acuity(BCVA)log MAR improved from 0.97±0.91 preoperatively to 0.24±0.23 postoperatively(P=0.003).Moreover,the SE decreased from-9.58±7.47D preoperatively to-0.65±2.21 D postoperatively(P<0.001).In terms of safety profile,the average IOP decreased from 21.10±12.94 mm Hg preoperatively to 14.03±3.57 mm Hg postoperatively(P=0.044),and the previously elevated IOP of three eyes decreased to the normal range.The ACD increased from 2.25±1.45 mm preoperatively to 3.35±0.39 mm postoperatively(P=0.017).The density of corneal endothelial cells did not change significantly after surgery(P=0.140).The posterior chamber IOLs were well centered and no severe complications were found.CONCLUSION:Lens removal plus the modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation can help in improvement of visual acuity,which can be regarded as a relative safe method for the surgical management of microspherophakia.

球形晶状体人工晶状体度数计算的准确性研究

目的比较Haigis、HofferQ、HolladayⅠ、SRK/T、Barrett universalⅡ、Hill-RBF3.0、Kane、EVO、Pearl-DGS人工晶状体(IOL)计算公式计算球形晶状体(MSP)患者IOL度数的准确性。方法对48例(77眼)行晶状体超声乳化吸除术联合IOL植入术的MSP患者术前进行生物学测量,术后进行综合验光,计算并比较9种公式的预测误差(PE)和绝对误差(AE),根据眼轴(AL)、前房深度(ACD)、角膜曲率(K)、晶状体厚度(LT)的不同分组比较各公式的屈光误差情况。结果9种IOL公式计算的PE和AE各组间总体差异无统计学意义,P值分别是0.47和0.76。但进一步检验显示,SRK/T和Hill-RBF3.0组间PE有统计学意义(P<0.05),PE分别为(0.62±1.38)D和(0.18±1.24)D,Hill-RBF3.0公式在PE≤0.5 D及PE≤1.0 D的患眼百分比均最高,分别为44.12%及66.18%,Hill-RBF3.0在浅ACD组及非浅ACD组均呈现低值,分别为0.08和0.24。Kane公式在短AL组和长AL组最准确,PE分别为0.02和0.1。K和LT在正常范围时IOL计算公式PE均<1。结论9种公式在MSP手术患者IOL预测的准确性中相类似,Hill-RBF3.0在不同ACD分组中显示出最小的PE,Kane公式在对AL的包容度更强,K和LT对公式计算的影响较小。

囊袋上经巩膜缝线固定IOL植入术治疗球形晶状体的有效性和安全性研究

目的:探讨超声乳化晶状体吸除联合囊袋上经巩膜缝线固定人工晶状体(intraocularlens,IOL)植入术治疗球形晶状体(microspherophakia,MSP)的有效性和安全性。方法:采用回顾性分析,选取2019年1月至2020年6月期间在复旦大学附属眼耳鼻喉科医院进行治疗的MSP患者37例(37眼),随机分为两组,纳入行超声乳化晶状体吸除联合囊袋上巩膜缝线固定IOL植入术(supra-capsular and scleral-fixated intraocular lens implantation,SCSF-IOL)的MSP患者20例(20眼)和行超声乳化晶状体吸除联合改良型囊袋张力环植入术(transscleral-fixated modified capsular tension ring and in-thebag intraocular lens implantation,MCTR-IOL)的MSP患者17例(17眼),观察两组术后最佳矫正视力及并发症等情况。结果:两组术后最佳矫正视力比术前均有改善(P<0.001),而组间比较差异无统计学意义(P=0.326)。两组的IOL倾斜度相当(P=0.216)。预防性Nd:YAG激光后囊膜切开术在SCSFIOL术后1周至1个月进行。在SCSF-IOL组,2眼(10.00%)需要重复激光治疗,1眼(5.00%)出现囊口偏心。后囊膜混浊是MCTR组最常见并发症(6眼,35.29%)。随访期间两组均未出现IOL脱位、继发性青光眼和视网膜脱离。结论:SCSF-IOL是治疗球形晶状体的简单易行的手术方式,疗效与MCTR-IOL相当。Nd:YAG激光后囊膜切开术是预防SCSF-IOL术后囊袋并发症的必要手段。

球形晶状体白内障术后合并黄斑水肿一例

球形晶状体是一种罕见的先天性晶状体悬韧带疾病,表现为晶状体前后径增加,赤道半径减小,类似球形。临床特点包括浅前房、晶状体源性高度近视、晶状体脱位及继发青光眼等。治疗上早期可以通过验光配镜提高视力,当继发晶状体脱位及青光眼时需尽早进行手术治疗。本例报道一例72岁男性患者,因右眼视力下降2年入院。既往近视,近视逐渐加深,近2年患者双眼配镜-10D,视力无明显改善。就诊后考虑球形晶状体所致晶状体不全脱位合并白内障,入院后行囊袋拉钩固定下白内障超声乳化+人工晶状体悬吊+前段玻璃体切割术。患者术后1个月后复诊,发现黄斑水肿,予以复方平地木颗粒口服,溴芬酸钠滴眼液滴眼。2周后复诊视力及黄斑水肿明显好转。

Marchesani综合征(附1例病例报告)

Marchesani综合征是一种以短指和球形晶状体为主要特征的综合征。临床表现为球形晶状体、晶状体脱位、青光眼、短指、身材矮小等。本文报告1例并结合复习文献,对本病的发病机制、临床特征及诊断治疗要点作一介绍。

球形晶状体的治疗进展

球形晶状体是一种罕见的先天性悬韧带晶状体疾病,常见的并发症为晶状体脱位或不全脱位和继发性青光眼,并发症发生时间早,致盲率高,因此尽早的诊断和治疗尤为重要。球形晶状体的治疗主要根据并发症的严重程度而定,可以分为晶状体手术和抗青光眼治疗,晶状体手术包括晶状体吸除+人工晶状体植入术、晶状体吸除+改良囊袋张力环植入+人工晶状体植入术等;抗青光眼手术包括YAG激光虹膜周切术、小梁切除术等。球形晶状体行晶状体手术后视力恢复明显,不同的抗青光眼手术后眼压控制效果不一,手术的长期有效性和安全性还有待观察。