微切口反向巩膜瓣人工晶状体睫状沟缝线固定术临床探讨

摘要

Objective To evaluate the reverse scleral pocket technique for micro-incision sulcus intraocular lens implantation in the absence of capsular support.Methods A retrospective case series study.Clinical data of 22 patients (22 eyes) who underwent secondary micro-incision sulcus intraocular lens implantation with the reverse scleral pocket technique in Wuhan Aier Ophthalmology Hospital from September 2013 to September 2014 were analyzed.After the surgery, the uncorrected visual acuity (UCVA), the best corrected visual acuity (BCVA) and the intraoperative and postoperative complications (including lens decentration and tilt) were checked up.Results The uncorrected visual acuity was ＜0.1 in 1 eye, 0.1-0.5 in 8 eyes, ＞0.5 in 13 eyes at 7 days after surgery.The uncorrected visual acuity was 0.1-0.5 in 7 eyes, ＞0.5 in 15 eyes at 3 months after surgery.The uncorrected visual acuity was achieved or over the preoperative best corrected visual acuity in 17 eyes at 3 months after surgery.The mean lens decentration was (0.41±0.28)mm.The mean lens tilt was (1.53±0.82)°.One patient who was excluded because of a failure reverse scleral pocket underwent iris fixation.The postoperative complications mainly included anterior chamber exudates in 3 eyes of 3 patients, temporary intraocular pressure elevation in 2 eyes of 2 patients.There were no severe complications such as subchoroidal hemorrhage, suture exposure, endophthamitis, retinal detachment and so on.Conclusions The reverse scleral pocket technique for micro-incision sulcus intraocular lens implantation is one of the minimally invasive, safe and efficient therapeutic for aphakia in the absence of capsule support.The further observation is needed for long-term outcome.%目的 评价微切口反向巩膜瓣人工晶状体经睫状沟缝线固定术.方法 回顾性系列病例研究.收集2013年9月至2014年9月在武汉爱尔眼科医院就诊的无囊膜或少量囊膜支撑的无晶状体眼22例(22只眼)的临床资料.均行二期微切口反向巩膜瓣人工晶状体经睫状沟缝线固定术.术后7d、3个月观察患者的裸眼视力(UCVA)、最佳矫正视力(BCVA)、术中及术后并发症(包括人工晶状体的偏心量和倾斜度).结果 术后第7d裸眼视力＜0.10者1只眼,0.1～0.5者8只眼,0.5以上13只眼.术后3个月裸眼视力0.1～0.5者7只眼,0.5以上15只眼,其中裸眼视力与术前最佳矫正视力比较,相同或提高者17例(17只眼).术后3个月人工晶状体的平均偏心量为(0.41±0.28) mm,平均倾斜度(1.53±0.82)°.1例在制备反向巩膜瓣失败后改行经虹膜缝线固定术,已排除在本研究之外.术后并发症包括前房渗出3例,暂时性高眼压2例.无1只眼出现脉络膜下出血、缝线外露、眼内炎、视网膜脱离等严重并发症.结论 微切口反向巩膜瓣人工晶状体经睫状沟缝线固定术治疗无囊膜或少量囊膜的无晶状体眼,手术操作损伤小,安全稳定,效果好.远期效果需要进一步观察.