Objective To explore the time and method of secondary intraocular lens (IOL) implantation in open-globe injury after vitrectomy and to analyze the efficacies and relative factors of the treatment.Methods This is a retrospective case series study.Clinical data of 78 eyes of 78 patients with open-globe injury who underwent secondary IOL implantation after vitrectomy in Tianjin Medical University General Hospital from 2007 to 2012 were analyzed.There were 27 eyes of 27 patients with penetrating iujury,36 eyes of 36 patients with intraocular foreign body (IFB),4 eyes of 4 patients with ocular rupture,and 11 eyes of 11 patients with eudophthalmitis.The IFB included magnetic foreign body in 23 eyes of 23 patients,glass foreign body in 6 eyes of 6 patients,and eyelash foreign body in 7 eyes of 7 patients.Thirty-one eyes of 31 patients were temponaded with silicone oil,and 47 eyes of 47 patients were temponaded with C3F8 during vitrectomv.The methods of IOL implantation included posterior chamber IOL implantation in 32 eyes of 32 patients and sulcus-fixed IOL implantation in 46 eyes of 46 patients.The examinations before IOL implantation mainly included visual acuity,slit lamp biomicroscope,direct and indirect ophthalmoscope,visual electrophysiology,corneal endothelium,B scan,ultrasound biomicroscope and intraocular pressure.Four eves of 4 patients underwent suturing of peripheral iris,and 5 eyes of 5 patients underwent suturing of iris laceration.The visual acuity ranged from light perception to 0.1 before vitrectomy.The mean follow-up time was 15 43 months with a range from 6 to 36 months.Results The mean interval between IOL implantation and vitrectomy was 2.5 ± 0.2 months with a range from 1.5 to 6 months.The best corrected visual acuity was from 0.1 to 1.0 after vitrectomy.The uncorrected visual acuity ranged from 0.1 to 0.8,and the best corrected visual acuity was from 0.1 to 1.0 after IOL implantation.The postoperative complications mainly included mild anterior chamber exudates in 4 eyes of 4 patients,temporary intraocular pressure elevation in 7 eyes of 7 patients,and recurrent retinal detachment in 2 eyes of 2 patients.Conclusions The appropriate interval of secondary IOL implantation in open-globe injury after vitrectomy is important.Posterior chamber IOL implantation is performed in eyes with integrity of posterior capsule,and IOL sutured in the sulcus in eyes without posterior capsule support.It is safe and effective for secondary IOL implantation in open-globe injury after vitrectomy.%目的 探讨开放性眼外伤玻璃体切除术后人工.晶状体(IOL)植入的手术时机、手术方式的选择及手术疗效.方法 回顾性系列病例研究.收集2007年1月至2012年9月于天津医科大学总医院眼科接受玻璃体切除术后二期IOL植入的开放性眼外伤患者78例(78只眼)的临床资料.其中眼球穿孔伤27例(27只眼),眼内异物36例(36只眼),眼球破裂伤4例(4只眼),眼内炎11例(11只眼).眼内异物中磁性异物23例(23只眼),玻璃异物6例(6只眼),睫毛异物7例(7只眼).玻璃体切除手术中硅油填充31例(31只眼),C3F8填充47例(47只眼).IOL植入方法包括后房型IOL植入32例(32只眼),睫状沟IOL缝线固定手术46例(46只眼).IOL植入术前进行视力、裂隙灯、直接和间接检眼镜、眼电生理、角膜内皮镜、眼B超、超生生物显微镜及眼压等检查.术中同时进行周边虹膜缝合术4例(4只眼),虹膜裂伤缝合术5例(5只眼).玻璃体切除手术前视力光感～0.1.随访时间平均(15±3)个月(6～36个月).采用配对t检验方法对比术前术后眼压的变化.结果 IOL植入距玻璃体切除手术平均时间(2.5±0.2)个月(1.5 ～6.0个月).玻璃体切除手术后最佳矫正视力0.1～1.0.IOL植人手术后裸眼视力0.1～0.8,最佳矫正视力0.1～1.0.术后并发症包括前房少量渗出4例(4只眼),暂时性高眼压7例(7只眼),视网膜脱离复发2例(2只跟).结论 开放性眼外伤玻璃体切除手术后IOL植入时机至关重要.对晶状体后囊膜完整者,可直接将IOL植入后房;如果无晶状体后囊膜支持,则采用睫状沟IOL缝线固定手术.开放性眼外伤玻璃体切除术后二期IOL植入安全有效.
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