眼科研究 2000年第2期第18卷 临床研究
作者:王燕 王诚忠
单位:200040 上海市华东医院眼科
关键词:人工晶状体植入术;迟发性眼内炎症反应
摘要 目的 提高对白内障囊外摘出人工晶状体植入术后并发迟发性眼内炎症反应的认识。方法 对35例术后眼内炎症病人进行门诊随访检查及药物治疗效果的观察,并跟踪随访3月~1年。结果 在手术后6个月内发病27只眼,6个月后发病8只眼。约占随访病人的1.8%。轻者视力下降,重者出现眼球萎缩。结论 迟发性眼内炎症反应是人工晶状体植入术后较后期的并发症,应及时治疗,减少因此病而导致的严重后果。
分类号 R 776
A clinical study of delayed intraocular inflammation after intraocular
lens implantation
Wang Yan,Wang Chengzhong.
Department of Ophthalmology,Hua Dong Hospital,Shanghai 200040
Abstract ObjectiveTo make better understanding of delayed intraocular inflammation induced by extracapsular cataract extraction and posterior chamber intraocular lens implantation.MethodsAnterior chamber reactions of 35 cases(35 eyes)with delayed intraocular inflammation were closely observed with slit lamp and were treated with steroid.The effects of the drug treatment were observed and the visual acuities were compared.The patients were followed up for 3 months to 1 a.ResultsPostoperatively,27 patients had complications in 2 weeks and 6 months,8 patients in 7~8 months.It was calculated for 1.8% of all followed-up patients.Intraocular reactions of 31 patients disappeared after treatment. 4 patients were caused atrophy at last because of slow recovey and frequent re-attacking.In addition,delayed intraocular inflammation also caused some other severe complications,which included iris adhesion(accounted for 26%),pre-membrane of lens(accounted for 9%)and secondary glaucoma(accounted for 1%).Many patients suffered from visual acuity decrease.Corrected visual acuity were <0.05 in 4 eyes and 0 .1~0.4 in 12 eyes and >0.5 in 19 eyes af ter treatment.ConclusionThe complication should be well recognized and be promptly treated to avoid severe results.
Key words intraocular lens implantation delayed intraocular inflammation
白内障囊外摘出人工晶状体植入术已广泛应用于临床,并取得了满意的效果。对于术后发生的一些并发症已有大量报道,而人工晶状体植入术引起的迟发性眼内炎症反应常被忽视,此并发症如不及时治疗,则可导致视力下降,甚至引起眼球萎缩。我院从1991~1999年随访白内障囊外摘出人工晶状体植入术后的病人中发现35例患者出现此并发症。现分析如下。
1 资料与方法
1.1 一般资料 35例病人35只眼,男性16例,女性19例,占人工晶状体植入术后随访病人的1.8%。年龄55~65岁,28只眼,65~70岁5只眼,71~78岁2只眼。糖尿病病人9例,占2 5%。35例病人中行双眼手术21例, 占60%,两眼手术时间相隔为1周至10天,均为第2次手术眼发病。术后发生眼内反应时间为2周~1月时23只眼,2~5月时8只眼,6~8月时4只眼。发病前矫正视力0.2~0.4为7只眼,0.5~1.0为28只眼。35例患者术前排除青光眼、虹膜睫状体炎史,无全身免疫性疾病史。手术经过顺利,术中无并发症发生。我们选择人工晶状体为Stoze、Chiron、康明等聚甲基丙稀酸甲脂(polymethylmethacrylate,P MMA)人工晶状体。
1.2 临床表现 轻者无明显不适,或有轻度眼红,视物模糊,重者可有明显的疼痛,眼红,视力下降。临床检查视力0.05~0.2为13只眼,0.3~0.5为18只眼,>0.5为4只眼。眼部结膜充血,前房KP为细点状,前房闪辉+~++为23只眼,+++~++++为6只眼,5只眼出现前房纤维素性渗出,1 眼出现前房无菌性积脓(经前房穿刺,细菌图片和培养均为阴性)。35只眼中8只眼出现虹膜 部分后粘连,1例出现全粘连,虹膜膨隆,眼压升高至40 mmHg(1 mmHg=0. 133 kPa)。
1.3 治疗 选用甲基强的松龙球旁注射,口服强的松20~30 mg,1次/日,局部滴糖皮质激素滴眼液1次/2 h,严重的病人静脉滴注地塞米 松5~10 mg,逐渐减量,3~5天改用口服强的松,持续3周~1月,托比卡胺滴眼液滴眼1~3次/日,门诊密切随访。
2 结果
2.1 本组病例经糖皮质激素治疗1~2周后炎症消退者31只眼,随访中未见复发。有4只眼前房反应严重,纤维素性渗出不易吸收,玻璃体内轻度混浊,经治疗急性炎症控制缓慢,慢性炎症反应达半年以上才逐渐缓解,但时有反复。虹膜严重后粘连,瞳孔闭锁,视力受到严重影响,眼球轻度萎缩,眼压4~7 mmHg。1只眼并发青光眼病人行激光虹膜打孔术,虹膜膨隆消失,眼压恢复正常。另外本组病例中有9只眼虹膜后粘连,3只眼晶状体前膜形成。
2.2 4例眼球萎缩患者中1例视力只有光感,另3例眼前数指和0.04, 1例继发青光眼的患者视力从0.4下降到0.2,其余患者均有不同程度影响(表1)。
表1 发病前后视力变化对比(例数)
Tab.1 Comparison of the visual ac uity before and
after intraocular inflammation
Visual acuity |
Befor e inf lammation |
After inflammation |
Light sensitivity |
0 |
1 |
Finger num ber~0.05 |
0 |
3 |
0.1~0.2 |
2 |
4 |
0.3~0.4 |
5 |
8 |
0.5~1.0 |
28 |
19 |
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