Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

Evaluation of suturless scleral fixation with posterior chamber foldable intraocular lens implantation

AIM: To assess the sutureless scleral fixation technique for posterior chamber foldable intraocular lens(PCIOL) implantation in aphakic eyes with insufficient or no capsular support. METHODS: A technique for sutureless intrascleral fixation of the haptics of a standard 3-piece PCIOL was used which ensures sutureless fixation by permanent incarceration of the haptics in a scleral tunnel parallel to the limbus. All patients were evaluated for preoperative status [visual acuity, refractive error, K readings, intraocular pressure(IOP) measurement, slit lamp examination, fundus examination and optical biometry], postoperative status and complications. Ultrasound biomicroscopy(UBM) was done for 10 cases to evaluate optic tilt. RESULTS: The study evaluated 42 eyes of 42 patients. The follow-up period was 6 mo. Improvement of best corrected visual acuity(BCVA) one line occurred in 10 cases(23.8%) and loss of one line in 3 cases(7.1%). Intraoperative complications included: haptic kink in 4 cases(9.5%), haptic breakage in 1 case(2.4%), haptic dislocation in 1 case(2.4%), haptic slippage in 3 cases(7.1%), IOL dislocation in 1 case(2.4%) and sclerotomy related bleeding in 1 case(2.4%). Postoperative complications included: transient mild vitreous hemorrhage in 3 cases(7.1%), choroidal detachment in 1 case(2.4%), cystoid macular edema(CME) in 1 case(2.4%), optic capture in 1 case(2.4%), subconjunctival haptic in 2 cases(4.8%), ocular hypotony in 4 cases(9.5%) and ocular hypertension in 1 case(2.4%). There were no cases of retinal detachment or endophthalmitis. UBM showed optic tilt in 3 cases(30%). CONCLUSION: Fixation of three-piece foldable IOL haptics in scleral tunnel parallel to the limbus-providedaxial stability and proper centration of the IOL with minimal or no tilt in most cases and a low complication rate during the follow up period which lasted 6 mo.

A knotless, one-haptic fixation of posterior chamber intraocular lenses: one-year results

AIM: To assess the results of a modified technique for scleral fixation of a posterior chamber intraocular lens(IOL) in eyes which had deficient of posterior capsular support.METHODS: This retrospective study was comprised of ten patients with deficient posterior capsular support who underwent one-haptic fixation of posterior chamber IOLs, between February 2010 and October 2011. IOL as implanted with one haptic supported on the capsular remnant and the other haptic drawn into the sulcus by anchoring suture without a knot. All patients were evaluated for pre- and postoperative visual acuity, lens centration, intra-and postoperative complications.RESULTS: A knotless, one-haptic fixation of posterior chamber IOLs has successfully been performed on ten eyes. All cases had inadequate capsular support(i.e. a capsular tear ranged from 5 to 7 clock hours). The average age was 74.25 ±8.87y(SD). The average postoperative uncorrected visual acuity was 0.51 log MAR.Complications included hyphema in one eye, a mild inflammatory reaction in the anterior chamber in two eyes, and a transient rise in IOP in one eye. Neither IOL tilt nor dislocation was observed and there were no later complications.CONCLUSION: In the presence of insufficient capsular support, a knotless, one-haptic fixation of posterior chamber IOLs is a safe and viable option which reduces the operation time, and minimizes postoperative suture-related complications.

New Management of Angle-closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective:To investigate the management of angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens(PC-IOL)implantation.Design:Retrospective,noncontrolled interventional case series.Participants:In36eyes with angle-closure glaucoma(ACG),there were18eyes with primary acute angle-closure glaucoma(PACG),14eyes with primary chronic angle-closure glaucoma(PCCG),3eyes with secondary acute angle-closure glaucoma(SACG)and 1eye with secondary chronic angle-closure glaucoma(SCCG).Intervention:Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures:Postoperative visual acuity,IOP,axial anterior chamber depth.Results:After a mean postoperative follow-up time of 8.81±7.45months,intraocular pressure was reduced from a preoperative mean of 23.81±17.84mmHg to a postoperative mean of 12.54±4.73mmHg(P=0.001).Mean anterior hamber depth was1.75±0.48mm preoperatively and2.29±0.38mm postoperatively(P=0.000).Best spectacle-corrected visual acuith in 36eyes ranged from0.01to0.7(20/200to20/30)postoperatively,which was better than preoperative VA ranging from hand movement to 0.4(20/50)(P=0.000).Conclusion:Phacoemulsification with posterior chamber foldable intraocular lens implantation can be a good alternative in treating angle-closure glaucoma,Eye Science 2000;16:22-28.

New Management of Malignant Glaucoma by Phacoemulsification with Posterior Chamber Foldable Intraocular Lens Implantation

Objective:To investigate the feasibility of phacoemulsification with posterior chamber foldable intraocular lens implantation in the management of malignant glaucoma. Patients and Methods:Fourteen patients with malignant glaucoma diagnosed in the Department of Glaucoma were enrolled in the study.12 patients developed malignant glaucoma after filtration surgery.1 developed after peripheral iridectomy.1 patient developed malignant glaucoma without any clear cause.Cataract phacoemulsification was performed.Posterior chamber intraocular foldable lens was implanted in 10 cases of patients.Results:All 14 patients were cured wiht normal intraocular pressure,normal anterior chamber depth and increased visual acuity.Conclusion:Phacoemulsification with posterior chamber foldable intraocular lens implantation is a good alternative in treating malignant glaucoma.

Comparison of Trans-scleral Fixation of PMMA and Foldable Intraocular Lens in Children

Purpose: To observe the difference of the effects of PMMA and foldable intraocular lenses (IOLs) trans-sclerally fixed in pediatric eyes. Methods: Thirty-two children (43 eyes) who had undergone trans-scleral fixation of IOL were retrospected, of whom 5 children were implanted PMMA IOL in both eyes, 6children were implanted PMMA IOL in one eye and foldable IOL in the other eye, 12children were implanted foldable IOL in one eye and 9 chilrden were implanted PMMA IOL in one eye. Mean age was 5.3 years ( range 2.5 ～ 12 years ). Twelve children had traumatic cataract and the others congenital cataract before lens extraction. Results: Foldable group (18 eyes ): Mean follow-up was 12.1 months. Visual acuity (VA): compared with the best corrected VA before IOL fixation, postoperative best corrected VA improved in 16 eyes, remained unchanged in 2 eyes. In 14 eyes, one or two stitches were needed to seal the incision. Complications: Severe anterior chamber reaction was seen in 3 eyes. Intraocular bleeding was found in 3 eyes. IOL decentration was detected in 1 eye. Iris capture of IOL was seen in one eye. PMMA group (25 eyes ):Mean follow-up was 20.3 months. Visual acuity (VA): compared with the best corrected VA before IOL fixation, postoperative best corrected VA improved in 19 eyes,remained unchanged in 5 eyes and got worse in one eye. In 24 eyes, one to three stitches were needed to seal the incision. Complications: Severe anterior chamber reaction was seen in 5 eyes. Intraocular bleeding was found in 4 eyes. IOL decentration was seen in one eye. Iris capture of IOL was seen in 3 eyes. Intraocular pressure elevated in one eye. Conclusion: Our study shows that trans-scleral fixation of IOL is a safe procedure in pediatric eyes. Foldable IOL showed similar effect compared with PMMA IOL in pediatric trans-scleral fixation. Eye Science 2001; 17:61 ～ 64.

A Clinical Analysis of 120 Cases with Traumatic Cataract Treated by Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation

Extracapsular cataract extraction was performed combined with posterior chamber intraocular lens implantation on 120 inpatients (122 eyes) with traumatic cataract from 1992 to 1997. The results revealed that this combined operation can make most of them get useful visual acuity, although they were often accompanied with several comlicated eye injuries. We think the most important thing is to choose suitable opertion time, the reasonable operation method and take close followup after operation.

Membrane Formation on the Surface of Implanted Posterior Chamber Intraocular Lenses

Purpose:To study the prevention and treatment of the membrane formation on the lens surface after extracapsular cataract extraction(ECCE)with posterior chamber intraocular lens(PCIOL)implantation.Methods:We reviewed the records of 312 cataractous patients that had undergone ECCEwith PCIOLimplantation between1989and1993,Postoperatively all pa-tients were examined under slit-lamp microscopy.The membrane formation on the surface of PCIOLin pupilar area was divided into four grades.Two mem-branes of surgical removal were observed under a transmission electrom mi-croscopy.One PCIOLof surgical removal was observed under a scanning electron microscopy.Results;Of312 patients,21 had the membrane formation on the surface of the PCIOL postoperatively.The incidence of the membrane formation was6.7%.Comparisone with cases of senile cataract showed the incidence to be significantly the highest among;1.patients who had traumatic cataract(P<0.05);2.pa-tients with complicated cataract(P<0.05).Interoperatively residual lens corten and rupture of posterior capsule,interval time betwwen the first and second eye operations less than 1month are the main factors of menbrane formation.The ultrastructure in membrane and cytology on the lens surface showed that the membrane on the surface of PCIOLs is usually composed of acellular protein film and cellular elements,including macrophages.fibroblast-like cells,epithelioid cells,giant cells,fibroblasts and collagen fibrils,etc.Conclusions:The cellular response on the surface of an implanted PCIOLis a chonic foreign-body inflammatory reaction and the membrane of the surfaceof implanted PCIOL is a reactive membrane of the foreign-body.Eye Science1995;11:131-135.

Corneal astigmatism correction with scleral flaps in trans-scleral suture-fixed posterior chamber lens implantation:a preliminary clinical observation

AIM: To study the impact of scleral flap position, under which the posterior chamber intraocular lenses (PC-IOL) were sulcus-fixed by trans-scleral suture, on cornea astigmatism. METHODS: Twenty-six aphakic or cataract eyes were comprised in this prospective noncomparative case series study. Eleven eyes had traumatic cataract removed without sufficient capsular support, 3 had blunt trauma with subluxated traumatic cataract, 8 had undergone vitreoretinal surgery and 4 had congenital cataract removed. The average age was 54 years (range 21-74 years), with 17 men and 7 women. The foldable PC-IOL was fixed in sulcus by trans-scleral suture. The incision for IOL implantation was made 1mm posterior to limbus along the steepest meridian of cornea, while scleral flaps to bury the knots of trans-scleral suture were made along the flattest meridian. All the surgeries were performed by a single doctor (Ma L), and the follow up was at least 13 months (range 13-28 months). The preoperative, 3 months and 1 year postoperative corneal curvature along the steepest and flattest cornea meridian and overall cornea astigmatism were compared. RESULTS: The curvature along the steepest meridian changed from 44.25 +/- 2.22D preoperatively to 44.08 +/- 2.16D at 3 months postoperatively, and 43.65 +/- 5.23D at 1 year postoperatively (P>0.05); the curvature along the flattest meridian changed from 41.24 +/- 2.21D preoperatively to 43.15 +/- 3.94D at 3 months postoperatively, and 42.85 +/- 5.17D at 1 year postoperatively (P<0.05); and the surgery induced astigmatism (SIA) on cornea was calculated by vector analysis, which was 2.42 +/- 2.13D at 3 months postoperatively, and 2.18 +/- 3.42D at 1 year postoperatively, the difference was statistically significant (P<0.05). CONCLUSION: The scleral flap made along the flattest meridian, under which the posterior chamber intraocular lenses (PCIOL) were sulcus-fixed by trans-scleral suture, can steepen the cornea in varying degrees, thus reducing preexisting corneal astigmatism.

New two-point scleral-fixation technique for foldable intraocular lenses with four hollow haptics

The study was to report a new two-point scleralfixation technique for foldable intraocular lenses with four haptics.Lenses were slid into the anterior chamber from a 2.8 mm corneal incision and fixed under two sclera flaps at two opposite points.The postoperative best-corrected visual acuities（BCVAs） of all patients were significantly better than their preoperative BCVA.The results demonstrate that two-point,scleral fixations of foldable,intraocular lenses might be practicable and effective.

Toric markers-assisted implantation of the scleral-fixated intraocular lens

AIM：To evaluate the efficacy of toric intraocular lens markers-assisted implantation of the scleral-fixated intraocular lens（SFIOL）.METHODS：From October 2010 to December 2013,all patients who had undergone secondary SFIOL implantation were assigned to group 1 and 2,in group 1SFIOL was performed with the assist of radial keratotomy（RK）-marker,and in group 2 SFIOL was performed with the assisted of toric intraocular lens markers（T-and axis markers）.Patients＇ demographic data and information on baseline preoperative visual acuity,indication for surgery and latest postoperative visual acuity were collected and analyzed.The haptic and optic positions were determined by ultrasound biomicroscopy.The optic tilt angle and decentration distance were measured.RESULTS：The study evaluated 43 eyes of 43 patients ranging in age from 3 to 66 y.Group 1 comprised 24 eyes（24 patients） and group 2,19 eyes（19 patients）.Uncorrected reoperative acuity was improved on all the eyes postoperatively.The improved postoperative acuity was significantly more in group 2 than that in group 1（1.11 ±0.38 vs 0.82 ±0.45 logMAR;F=4.85,P=0.03）.Ultrasonic biomicrograph examination showed that the rate of haptic asymmetry was significantly higher in group 1（42%,10/24） than that in group 2（11%;2/19）（Chi square=3.68,P=0.04）.The mean tilted degree in group 1was significantly higher than that in group 2（P=0.04）.Mean decentration distance in group 1 was greater than that in group 2（P=0.03）.CONCLUSION：During SFIOL the toric markers help the surgeon identify the placement of fixation more precisely than that with the use of RK marker.

High speed small gauge anterior vitrectomy cutter for scleral fixated intraocular lens implantation

AIM： To report the outcomes of anterior vitrectomy using high speed cutter for scleral fixated intraocular lens （SFIOL） implantation in patients with posterior capsular rupture .METHODS： Medical records of 51 patients with posterior capsular rupture who received high speed cutter anterior vitrectomy via limbal incision with SFIOL implantation from June 2011 to December 2013 were reviewed retrospectively for visual outcomes and complications.RESULTS： Totally 51 eyes of 51 patients were identified （23 males and 28 females）. Mean age at surgery was 67.2±15y （range 27-91y）, with mean follow-up of 23±8.2mo （range 12-40mo）. The 49 （96.1%） eyes had improvement or unchanged of final postoperative visual acuity. The most common complication was vitreous haemorrhage （5.9%） and transient rise in intraocular pressure （5.9%） which all spontaneously resolved CONCLUSION： High speed cutter anterior vitrectomy via limbal incision is a safe and effective method for those with posterior capsular rupture for SFIOL implantation.

Clinical Effect Analysis of Posterior Chamber Intraocular Lens Implantation for Correcting High Myopia and Astigmatism

Objective:To explore the corrective effect of posterior chamber intraocular lens implantation with phakic eyes in the treatment of high myopia and astigmatism.Methods:From May 2023,the hospital began to collect the case data of diagnosis and treatment of high myopia and astigmatism.By May 2024,310 cases were included,all of which were treated with posterior chamber intraocular lens implantation.The visual acuity,astigmatism and axial position of the intraocular lens were observed before and after treatment.Results:At different time points after the operation,the patient’s vision was significantly improved compared with that before the operation(P<0.05),and the vision level was equal to or greater than the best-corrected vision before the operation.At different time points after the operation,the average rotation of the intraocular lens was less than 5 degrees.Astigmatism was significantly lower than that before the operation(P<0.05).After the operation,the intraocular pressure increased in 11 cases,accounting for 3.55%,with no adverse complications such as lens turbidity,glare and obvious halo occurring.Conclusion:The posterior chamber intraocular lens implantation with phakic eyes has an ideal correction effect in the treatment of high myopia and astigmatism,which can effectively improve the vision level of patients and reduce the degree of astigmatism,and has high effectiveness and safety.

Comparison of iris-fixated foldable lens and scleralfixated foldable lens implantation in eyes with insufficient capsular support

AIM： To compare the outcomes of vision using two different intraocular lens（IOL） replacement techniques,iris-fixated foldable intraocular lens（IF-IOL） and scleralfixated foldable intraocular lens（SF-IOL） in patients with insufficient capsular support.METHODS： Total 63 eyes（62 patients） with insufficient posterior capsule support underwent replacement of IF-IOL or SF-IOL between January 2008 and August 2011.Outcome measures included changes in visual acuity, slit lamp examination, refractive indices and corneal curvatures. RESULTS： The mean improvement of uncorrected visual acuity（UCVA） was greater in IF-IOL group compared to the SF-IOL group（0.43 D±0.19 D vs 0.35 D±0.18 D, P 〈0.05）. Moreover, 12（38.71%） eyes in IF-IOL group and 4（12.50%） in SF-IOL group had a higher postoperative UCVA than preoperative best corrected visual acuity（BCVA） while 9（29.03%） eyes in IF-IOLgroup and 18（56.25%） in SF-IOL group had a lower postoperative UCVA than preoperative BCVA. The myopic mean manifest sphere and mean cylinder magnitude were lower in the IF-IOL group than that in the SF-IOL group（-0.47 D±0.58 D vs 0.50 D±0.43 D, P 〈0.01; 0.84 D ±0.53 D vs 1.23 D ±0.70 D, P 〈0.05）. No difference of corneal astigmatism and surgically induced astigmatism was found between the two groups. In addition, fewer complications were observed in IF-IOL eyes. CONCLUSION： IF-IOL implantation can give a significant improvement in vision with fewer complications than SF-IOL in patients with insufficient capsular support.

Y-Shaped Intra-Scleral Fixated Lens versus Retro-Pupillary Iris Claw Lens in the Treatment of Aphakia

Background: Many reasons can lead to an aphakia without adequate capsular support for implantation of a posterior chamber intraocular lens (IOL), such as intraoperative unintentional rupture of posterior capsule during phacoemulsification, planned intracapsular cataract extraction, ocular trauma and lens dislocation due to congenital and acquired causes. Purpose: To compare Y-shaped intra-scleral fixation of a posterior chamber IOL with retro pupillary fixation of an iris-claw intraocular lens (IOL) for Aphakic eyes without sufficient capsular support as respects safety, visual recovery and complications of both methods. Patients and Methods: One hundred Aphakic eyes were arbitrarily distributed between two groups. Group A included 50 eyes treated with retropupillary fixation of iris claw lens and group B included 50 eyes treated with Y-shaped intra-scleral fixation technique. Preoperative, intraoperative and postoperative data were analysed including best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical time, intraoperative problems, IOL malposition and postoperative complications. Following up on patients was carried out for at least six months. Results: The mean duration of surgery was 21 ± 5.3 min in group A and was 53.4 ± 6.9 min in group B (p-value 0.05). IOL tilt was found in 0 (0%) eyes in group A and in 5 (10%) eyes in group B (p 0.05). Conclusion: The results of our study indicated that both methods are satisfactory in correcting aphakia without sufficient capsular support as regards postoperative best corrected visual acuity (BCVA);however the surgical technique of retropupillary iris claw lens is easier, shorter, with low intra- and postoperative complications and safer than those used for intra-scleral fixation of IOL. But for eyes which lack both iris and capsular support, a scleral fixation of a posterior chamber IOL remains the only option.

Evaluation of functional outcome and stability of sutureless scleral tunnel fixated IOLs in children with ectopia lentis

AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18 y having>7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation.Primary outcome was improvement in best corrected visual acuity(BCVA)and secondary outcomes were assessment of intraocular lens(IOL)tilt using ultrasound biomicroscopy(UBM),mean change in astigmatism at last follow-up of 1 y and associated complications.RESULTS:The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45(log MAR)respectively(P=0.001)at last follow-up.The mean astigmatism preoperatively and postoperatively was-4.17±2.69 D and-1.86±1.25 D respectively(P=0.011).Significant IOL tilt(>5 degrees)was present in 5 cases.The mean percentage endothelial loss was 3.65%±1.92%.The most serious complication encountered was retinal detachment seen in 2 cases.CONCLUSION:SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection.We recommend caution in children having white-to-white distance>12 mm and presence of peripheral retinal degenerations.

一种改良微创人工晶状体固定术的临床观察

目的:观察隐形锚钩式巩膜层间人工晶状体固定术的临床效果。方法:前瞻性非对照性病例研究。选取2019-01/2020-12我院收治的无晶状体、人工晶状体脱位或晶状体脱位患者19例19眼,所有患者均接受锚钩式人工晶状体巩膜层间固定植入手术。观察手术前后最佳矫正视力(BCVA)、裸眼视力(UCVA)、角膜内皮细胞密度、术后人工晶状体位置有无倾斜和并发症。结果:术前和术后1 mo,UCVA(LogMAR)为1.06±0.63和0.40±0.26(P<0.01),BCVA(LogMAR)为0.27±0.51和0.06±0.15(P=0.09),角膜内皮细胞密度为2406±625和2004±759 cells/mm~2(P=0.13)。术后1d房水闪辉2级或以上3眼,角膜后弹力层皱褶2眼,一过性眼压升高2眼。随访24 mo均未发生人工晶状体脱位。结论:锚钩式人工晶状体巩膜层间固定技术,组织间线头顺行进入-逆向固定,类似锚钩原理,达到了良好的人工晶状体稳定性和视觉效果。

后巩膜葡萄肿对高度近视白内障患者术后人工晶状体稳定性的影响

目的探究后巩膜葡萄肿对高度近视白内障患者术后人工晶状体稳定性的影响。方法57例(63眼)行白内障超声乳化联合人工晶状体植入术的白内障伴高度近视患者根据是否存在后巩膜葡萄肿分研究组(26例共28眼,合并后巩膜葡萄肿)和对照组(31例共35眼,单纯白内障伴高度近视)。对比两组术前眼轴,术后3个月眼轴、中轴区晶状体后囊膜至视网膜距离、前房深度、角膜曲率、最佳矫正视力(BCAV)、平均绝对屈光误差(MAE)、人工晶状体囊袋偏心量及倾斜角。结果研究组术前及术后3个月眼轴长度、术后3个月BCAV、裸眼视力数值(logMAR)、MAE、水平及垂直方向的倾斜角、前房深度均高于对照组(P<0.01或0.05)。结论高度近视合并巩膜葡萄肿患者行白内障手术时应关注人工晶状体的稳定性。

先天性晶状体脱位患者术后人工晶状体脱位的原因及其危险因素分析

目的探究先天性晶状体脱位(CEL)患者经巩膜人工晶状体(IOL)缝襻固定术后发生IOL脱位的原因及其危险因素分析。方法对123例(220眼)接受经巩膜IOL缝襻固定术的CEL患者进行回顾性分析,所有患者均接受全面的眼科检查,包括视力(VA)、眼压(IOP)及IOL位置等。采用广义估计方程分析评估CEL患者术后IOL脱位的危险因素。结果在随访期间(随访时间:36~94个月;中位随访时间:48个月),共有16例(17眼)术后发生IOL脱位,发生时间为术后2~78个月,平均为术后(38.2±23.3)个月。缝线断裂、缝线松脱、IOL襻断裂和术后眼外伤是导致IOL脱位的主要原因。广义估计方程分析显示,男性(OR:7.897,95%CI:1.025~60.859,P=0.047)、三片式IOL(AR40e,OR:3.344,95%CI:1.092~10.237,P=0.034)、眼外伤(OR:18.874,95%CI:2.271~156.849,P=0.007)及术后眼轴增长(OR:2.215,95%CI:1.022~4.800,P=0.044)是CEL患者术后IOL脱位的危险因素。结论IOL脱位是CEL患者经巩膜IOL缝襻固定术后的一种相对罕见但重要的远期并发症,其中缝线断裂和松脱为主要原因。因此,在缝线的选择和手术固定技术方面仍需要进一步研究和优化,以降低术后IOL脱位的风险。同时术后应加强随访,特别是对于男性患者,以便及时发现和处理可能出现的并发症。

后房型人工晶状体脱位的巩膜缝线固定置换术的临床应用

目的通过对巩膜缝线固定置换后房型人工晶状体(IOL)手术治疗中远期IOL脱位的手术前后比较,评价术式的临床疗效。方法回顾性病例研究。纳入2022年3月—2024年3月期间于浙江大学医学院附属第二医院行手术治疗的中远期IOL脱位患者19例(23眼),行巩膜缝线固定置换后房型IOL手术治疗。统计患者手术前后的裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压(IOP)、角膜内皮计数和术后并发症的发生率。结果经过1个月~1年的随访,患者术后的UCVA、BCVA均较术前提高(P<0.05),IOP较术前差异无统计学意义(P>0.05),无相关严重并发症。结论巩膜缝线固定置换后房型IOL手术对中远期IOL脱位具有较好的临床疗效。