【摘要】
目的 探讨重建眼前段结构，以机化膜为依托行二期后房型人工晶状体植入手术的方法,并评价其疗效。
方法 对不同程度眼前段结构紊乱86只眼行眼前段结构重建及人工晶状体植入术。包括部分穿透性角膜移植术、前粘连松解术、虹膜根部离断缝合术、后粘连松解术、瞳孔成形术、瞳孔区机化膜造孔术及以机化膜为依托的二期后房型人工晶状体植入术。随访3～32个月。
结果 86只眼手术顺利。术后视力≥0.5者71只眼(82.6%)，其中≥0.9者34只眼(39.5%)，≤0.2者15只眼(17.4%)；术后人工晶状体位置正位68只眼(79.1%)，略偏离中心者18只眼（20.9%）；术后5只眼前房出血，4只眼经保守治疗全愈，1只眼自原切口吸出前房血膜。全部病例术后炎性反应轻微，无严重远期并发症。结论 重建眼前段结构，在预植入人工晶状体襻的部位存在机化膜可支撑人工晶状体，即无需采用缝线固定的方法，这样可避免因缝线所致的各种并发症发生。
Anterior segment reconstruction and secondary posterior chamber intraocular lens implantation supported by fibromembrane
XIONG Quanchen, GUO Rongxia, FENG Zhaohui,et al.
（Department of Ophthalmology, Affiliated Second Hospital, Xi'an Medical University, Xi'an 710004, China）
【Abstract】 Objective To evaluate the methods and effects of anterior segment reconstruction and secondary posterior chamber intraocular lens (IOL) implantation supported by fibromembrane in pupillary area. Methods Anterior segment was reconstructed in 86 eyes with different anterior segment disorders. Anterior segment reconstruction includes: partial penetrating keratoplasty, loosing front adhesion, suturing detached peripheral iris, loosing rear adhesion, reshaping pupil, perforating fibromembrane in the pupillary area. The IOL was secondarily implanted into the posterior chamber, and the patients were followed up in 3-32 months. Results The surgery was successful in all patients. The postoperative visual acuities in 71 eyes were ≥0.5 (82.6%), including ≥0.9 (39.5%) in 34 eyes and ≤0.2 in 15 eyes (17.4%). After IOL implantation, the IOL correctly centered was in 68 eyes (79.1%), and deviated in 18 eyes (20.9%). Anterior chamber hemorrhage occurred in 5 eyes, 4 of them were recovered by conservative treatment and the blood membrane in another eye was sucked out through its primary incision. All patients had slight postoperative inflammation and without severe long term complications. Conclusion With the support of enough fibromembrane in pupillary area, anterior segment reconstruction and secondary posterior chamber IOL implantation can be performed, thus IOL suture fixation is not necessary, and its associated complications can be avoided.
【Key words】 Lenses, intraocular； Anterior segment reconstruction
随着眼科显微手术技术的不断普及和提高，手术设备的不断完善，白内障囊外摘除联合后房型人工晶状体植入术已成为眼科临床的常规手术；而严重外伤致眼前段结构紊乱患者摘除晶状体后人工晶状体植入的可行性及方法，是眼科同道及眼科临床关注和研究的重要课题。我们自1996年开始对眼球穿孔伤致眼前段结构紊乱患者，开展重建眼前段、以瞳孔区机化膜为依托行后房型人工晶状体植入手术，获得满意的临床效果，现将结果报告如下。
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