人工晶狀體囊袋內(nèi)縫合固定治療外傷性晶狀體半脫位

劉　剛，高　豐，戴襄軍，劉月君，李　芳

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人工晶狀體囊袋內(nèi)縫合固定治療外傷性晶狀體半脫位

劉剛，高豐，戴襄軍，劉月君，李芳

Department of Ophthalmology, Xiangyang Hospital, Hubei University of Medicine, the First People’s Hospital of Xiangyang, Xiangyang 441000, Hubei Province, China

?METHODS: Twelve eyes with lens subluxation from 12 patients during Mar. 2013 to Mar. 2015 were reviewed. The stopping and chopping method combined with manual nuclear extraction was performed in extent of lens subluxation less than 1/2 quadrant and transscleral sutured fixation intraocular lens implanted in the capsular. Visual acuity, best-corrected visual acuity, intraocular pressure, corneal endothelial cell count and the position of IOL were observed and recorded.

?RESULTS: All the surgeries were performed successfully. Patients were followed up for 6-12mo. During the follow-up period, the number of eyes for BCVA ≥0.8, 0.4-0.6 and ≤0.3 was 2, 7 and 3, respectively. It meant 66.67% of the eyes showed BCVA in 0.5-0.6. Intraocular pressure and the position of all intraocular lens were normal. Effects of operation on corneal endothelial cells were slight. No complications took place in and after surgery.

?CONCLUSION: Without implanting capsular tension ring (CTR), we successfully use the intraocular lens (IOL) single loop suture fixation in the capsular bag for the treatment of the patient with traumatic lens dislocation. It indicates that the pressure and place shift from the use of IOL avoided by this method without implantation of CTR. This method is safe and effective for the treatment of eyes with traumatic lens dislocation.

目的：評(píng)價(jià)人工晶狀體(intraocular lens，IOL)單襻囊袋內(nèi)縫合固定治療外傷性晶狀體半脫位手術(shù)的方法、效果及可行性。

方法：選擇2013-03/2015-03我院術(shù)前晶狀體脫位范圍不大于2個(gè)象限的外傷性白內(nèi)障患者12例12眼，行攔截劈裂超聲乳化白內(nèi)障吸除術(shù)或小切口晶狀體摘除術(shù)。IOL采用單襻囊袋內(nèi)縫合固定術(shù)，即一側(cè)襻植入未見明顯脫位方位囊袋內(nèi)，將聚丙烯縫線捆綁另一側(cè)襻的中部后穿過囊膜赤道部固定鞏膜壁的方法植入脫位最嚴(yán)重方位的囊袋內(nèi)。術(shù)后觀察裸眼視力、最佳矯正視力(best corrected visual acuity，BCVA)、眼壓、角膜內(nèi)皮細(xì)胞計(jì)數(shù)、IOL位置等指標(biāo)，并對(duì)手術(shù)并發(fā)癥進(jìn)行記錄。

結(jié)果：手術(shù)完成均順利，術(shù)后視力提高明顯，術(shù)后隨訪6～12mo，隨訪期間BCVA≥0.8者2眼，0.4～0.6者7眼，≤0.3者3眼，67%的視力穩(wěn)定在0.5～0.6；術(shù)后隨訪期間眼壓正常，手術(shù)對(duì)角膜內(nèi)皮細(xì)胞影響輕微，所有IOL均處于正位，術(shù)中、術(shù)后未有嚴(yán)重并發(fā)癥發(fā)生。

結(jié)論：在不植入囊袋張力環(huán)(capsular tension ring，CTR)的情況下，使用IOL單襻囊袋內(nèi)縫合固定治療外傷性晶狀體半脫位，可顯著提高患者的BCVA，并且安全性好，有效地避免了IOL的夾持和偏位，臨床療效滿意。

人工晶狀體；外傷性晶狀體半脫位；囊袋內(nèi)縫合固定

引用：劉剛，高豐，戴襄軍，等.人工晶狀體囊袋內(nèi)縫合固定治療外傷性晶狀體半脫位.國際眼科雜志2016;16(11):2130-2132

0　引言

最初的文獻(xiàn)報(bào)道稱，晶狀體半脫位的手術(shù)治療術(shù)中、術(shù)后并發(fā)癥多，并且視力改善有限， 曾被列為超聲乳化手術(shù)的絕對(duì)禁忌證[1]。……