晶状体切除联合巩膜缝线固定人工晶状体植入术治疗先天性晶状体半脱位的长期效果

摘要

目的:分析先天性晶状体半脱位患眼经晶状体切除+前段玻璃体切割+经巩膜缝线固定人工晶状体(IOL)植入术后长期治疗效果.方法:回顾性系列病例研究.观察2005年1月至2014年6月期间于复旦大学附属眼耳鼻喉科医院收治的先天性晶状体半脱位患者53例(77眼),所有患眼均接受一期晶状体切除+前段玻璃体切割+经巩膜缝线固定IOL植入术.对术后最终随访时最佳矫正视力(BCVA)、眼压及术眼出现的主要并发症进行系统性的临床观察.数据采用配对t检验或独立样本t检验进行比较.结果:77例接受一期晶状体切除+前段玻璃体切割+经巩膜缝线固定IOL植入术的先天性晶状体半脱位患眼,术后随访时间为(38±26)个月,最短12个月,最长130个月.术前BCVA(LogMAR)为0.84±0.55,术后为0.26±0.43,术后视力较术前明显改善(t=8.55,P<0.001).术中及术后早期并发症包括:1眼(1.3％)术中视网膜脱离,2眼(2.6％)术后早期前房积血,2眼(2.6％)术后早期切口玻璃体嵌顿.术后远期并发症包括:6眼(7.8％)视网膜脱离,发生于术后(22±12)个月,1眼(1％)IOL移位或脱位,发生于术后5年.术后不良主诉包括:32例(60.4％)术后随访时主诉干眼症状,6例(11.3％)主诉眩光现象.结论:晶状体切除前段玻璃体切割+经巩膜缝线固定IOL植入术可以显著提高先天性晶状体半脱位患者视力.远期随访中,视网膜脱离及IOL脱位是尤其需要警惕的术后并发症.%Objective: To assess the long-term outcome and complications profile of primary scleral-fixated posterior chamber intraocular lenses in patients with congenital lens subluxation. Methods: In this retrospective case series study, all patients who had undergone lens surgery between January 2005 and June 2014 were reviewed for visual outcomes and complications. Demographic data and information on baseline preoperative best corrected visual acuity (BCVA), intraocular pressure (IOP) before surgery, indication for surgery, intraoperative complications, postoperative complications, last postoperative visual acuity, intraocular lens position, and indication for any subsequent surgical procedures were collected and analyzed using paired t-tests and independent t-tests. Results: Patients mean age at surgery was 23±20 years (5 to 67 years), with a mean follow-up of 38±26 months (12 to 130 months). For the 77 eyes included, the mean preoperative BCVA (LogMAR) was 0.84±0.55, which improved significantly to 0.26±0.43 postoperatively (t=8.55,P<0.001). IOP decreased only in patients with spherophakia. Complications included transient intraocular hemorrhage (2 eyes, 2.6％), early vitreous incarceration (2 eyes, 2.6％), retinal detachment (6 eyes, 7.8％), and intraocular lens dislocation (1 eye, 1.3％). Conclusions: Based on long-term follow-up data, primary scleral-fixated posterior chamber intraocular lenses can significantly improve visual acuity in patients with congenital lens subluxation. However, ophthalmologists should be alert for potential long-term postoperative complications.