Objective To compare the efficacy and complications of Artisan iris claw intraocular lens implantation with those of posterior chamber intraocular lens implantation with ciliary sulcus suture fixation for correction of aphakia in vitrectomized eyes without capsular support.Methods This was a prospective interventional case series.From Jan 2009 to Feb 2012,53 aphakicvitrectomizedeyes without sufficient capsular support were divided into two groups according to the condition of residual capsule.Group one:28 eyes received Artisan iris claw intraocular lens implantation.Group two:25 eyes received posterior chamber intraocular lens implantation with ciliary sulcus suture fixation.The best corrected visual acuity and intraocular pressure,corneal endothelial cell loss rate,duration of surgery and complications were compared between two groups.Two-independent t-test,Mann-Whitney test and x2 test were used to analyze measurement data of normal distribution,non-normal distribution and count data respectively.Results The mean duration of surgery in group one [(11.23 ± 1.54) min] was much shorter (t =-26.60,P ＜ 0.05)than that in group two [(31.68-3.15)min].The endothelial cell loss rate of group one were (4.39 ±1.85)％,(4.76-±2.06)％ and (6.30 ±2.71)％ at 3 months,6 months and 1 year after surgery,and the data of group two were (3.92 ± 1.85)％,(4.33 ± 1.80)％ and(5.73 ±2.12)％.No statistically significant difference was noted between two groups at any time point(t =0.77,0.66,0.69;P ＞ 0.05).The best corrected visual acuity of group one (0.40,0.12-0.80) was better than that of group two (0.30,0.08-0.60) at 1 day after surgery (t =-2.16,P ＜ 0.05).However,there was no statistically significant difference at 1 month and 3 months after surgery (P ＞ 0.05).The intraocular pressure of group two [(11.63±2.29)mmHg,1 mmHg=0.133 kPa] was much lower (t=2.34,P＜0.05) than that of group one[(13.61 ± 3.37) mmHg] at 1 day after surgery.There was no statistical significant difference at 1 month and 3 months after surgery between two groups (P ＞ 0.05).The postoperative complications of group one were anterior uveitis,iris depigmentation,pupillary distortion and spontaneous lens dislocation.Those of group two were choroidal detachment,intraocular haemorrhage,intraocular lens decentration and retinal detachment.Conclusions Iris claw intraocular lens implantation is a simple,fast,less complications and minimally invasive method for the correction of aphakic eyes after vitrectomy.There were on difference in stability and safety between these two implantation methods.Due to the difference of indication choice,either of them can be a viable complement for the other.%目的 比较Artisan虹膜固定型IOL植入术与后房型IOL睫状沟缝线固定术治疗玻璃体切除术后无囊膜支持的无晶状体眼的安全性及临床疗效.方法 前瞻性研究.将2009年1月至2012年2月期间就诊于天津医科大学眼科医院的53例(53只眼)无囊膜支撑的无晶状体眼患者,根据术眼残余囊膜的情况分为两组,Artisan植入组(A组):28只眼,行Artisan虹膜固定型IOL植入术;睫状沟缝合组(B组):25只眼,行后房型IOL睫状沟缝线固定术.随访1年,比较两组患者手术时间、角膜内皮细胞丢失率、手术并发症及术后BCVA及眼压的情况.其中计量资料满足正态分布的采用两独立样本t检验进行组间比较,不满足正态分布的行Mann-Whitney检验,对计数资料行x2检验.结果 Artisan植入组平均手术时间(11.23±1.54)min明显短于睫状沟缝线固定组(31.68±3.15) min,差异有统计学意义(t=-26.60,P＜0,05).术后3个月、6个月、1年,Artisan植入组患者角膜内皮细胞丢失率分别为(4.39％±1.85％)、(4.76％±2.06％)、(6.30％±2.71％),睫状沟缝线固定组分别为(3.92％±1.85％)、(4.33％±1.80％)、(5.73％±2.12％),2组差异无统计学意义(t =0.77,0.66,0.69;P ＞0.05).Artisan植入组术后第1天BCVA为0.40(0.12,0.80),好于睫状沟缝线固定组0.30(0.08,0.60)(t=-2.16;P＜0.05),术后1、3个月2组BCVA差异无统计学意义(t=-0.56,-0.73;P＞0.05).睫状沟缝线固定组术后第1天眼压[(11.63±2.29) mmHg,1mmHg=0.133 kPa]明显低于Artisan组[(13.61±3.37)mmHg],差异有统计学意义(t=2.34,P＜0.05),术后l、3个月2组眼压无差异.Artisan植入组术后并发症包括虹膜炎症反应、虹膜脱色素、瞳孔L变形及IOL自发性脱位.睫状沟缝合组术后并发症主要为脉络膜脱离、眼内出血、IOL光学面倾斜及视网膜脱离.结论 Artisan虹膜固定型IOL植入术手术时间短、操作简单、组织损伤小、并发症较少,在稳定性、安全性方面与后房型IOL睫状沟缝线固定术相比无明显差别,两种术式由于在适应证的选择上各有侧重,在治疗玻璃体切除术后的无囊膜支撑的无晶状体眼疗效方面可以互为补充.
展开▼
