眼科研究 2000年第4期第18卷 临床研究
作者:廖武 曾广川 詹卫群 叶计芬
单位:512026广东省韶关市粤北人民医院眼科
关键词:切口;晶状体;人工
摘要 目的评价无缝线切口二期后房型人工晶状体植入术的疗效。方法对22眼无晶状体眼患者分别采用3.5mm(A组10眼)及5.5mm(B组12眼)的反眉状巩膜隧道切口,二期植入6mm折叠式丙烯酸脂类及一体式PMMA后房型人工晶状体,并与同期12眼6mm常规角膜缘切口(C组),二期6mm一体式PMMA后房型人工晶状体植入对比。结果随访3~15个月,无缝线切口组术后矫正视力均优于及等于术前最佳矫正视力,其中≥0.5者A组9眼(90%),B组9眼(75%)。缝线切口组,术后矫正视力优于及等于术前最佳矫正视力10眼(83.5%),≥0.5者7眼(58.3%)。结论采用无缝线切口二期后房型人工晶状体植入可明显降低角膜散光,减轻术后炎症反应及增加手术的安全性,是矫正无晶状体眼屈光不正的一种较理想的方法。
分类号 R776
Sutureless incision for secondary posterior chamber intraocular lens implantation
Liao Wu Zeng Guangchuan Zhan Weiqun et al.
(Department of Ophthalmology,YueBei People’s Hospital,Guangdong 512026)
Abstract ObjectiveTo evaluate the effect of sutureless incision for secondary posterior chamber intraocular lens(IOL) implantation.MethodsAn antisupetciliary scleral tunnel incision in 22 aphakic eyes were separately taken with 3.5mm(group A 10eyes)and 5.5mm(group B 12eyes).Secondary 6mm foldable acrylic and an integral PMMA(polymethylmetha-cnjlate) posterior chamber IOL were implanted.In the same period,a conventional 6mm limbal incision in group C(12eyes)was taken and a secndary 6mm integral PMMA posterior chamber IOL was implanted.The effects of the two procedures were compared.ResultsAfter a follow-up survey over 3-15 months,the sutureless incision group achieved a postoperative corrected visual acuity better than or equal to the best corrected visual acuity before the surgery.9 of group A eyes(90%)and 9 of the group B eyes(75%)achieved a corrected visual 0.5 or better.In the suture incision group,the postoperative corrected visual acuity was equal to or better than the best corrected visual acuity of the preoperation in 10 eyes(83.5%);corrected visual acuity 0.5 or better in 7 eyes(58.3%).ConclusionThe sutureless incision for secondary posterior chamber IOL implantation can not only clearly decrease cornea astigmatism,but also reduce the postoperative inflammatory reaction and increase the safety of operation.It is a good method to correct ametropia of the aphakic eyes.
Key words incision lens,intraocular
由于种种原因,部分眼疾患者未能一期植入人工晶状体而成为无晶状体眼,二期后房型人工晶状体植入是矫正其屈光不正的理想方法。通常采用6mm角膜缘切口植入,手术切口需缝合。我们采用了无缝线切口及侧切口玻璃体剪分离虹膜后粘连技术,完成了22眼二期后房型人工晶状体植入,并与同期12眼角膜缘缝线切口对比,随访3~15个月,效果满意,报告如下。
1 资料与方法
1.1 一般资料 本文共32例(34眼),其中男20眼,女14眼,年龄5~72岁,平均40.6岁±25.6岁。无晶状体眼时间6月~4年。分为3组,A组(10眼):采用3.5mm巩膜隧道切口并6mm折叠式丙烯酸脂类(Alcon MA60BM)人工晶状体植入;B组(12眼):采用5.5mm巩膜隧道切口并6mm一体式PMMA人工晶状体(Alcon TYPE1C)植入;C组(12眼):采用6mm角膜缘切口并6mm一体式PMMA人工晶状体植入。其中A组后囊膜完整(6眼)或中央后囊部分缺损(4眼),虹膜无粘连或粘连较轻,瞳孔散大<6mm。B组及C组后囊膜完整或后囊缺损但有足够支撑人工晶状体双袢的周边后囊存在(因无后囊或后囊缺损较大不能支撑人工晶状体双袢行无缝线切口及角膜缘切口二期人工晶状体缝合固定术及角膜曲率不能测量者不在此观察范围)。
1.2 手术方法:术前先用眼科A/B超测量术眼眼轴,并用角膜曲率计测角膜曲率,使用SRK公式电脑计算并打印出人工晶状体度数,常规球后麻醉。A组在上方或颞侧角膜缘后2mm作3.5mm反眉状巩膜隧道切口,注入Healon,作侧切口,用玻璃体剪分离虹膜后粘连,再次用Healon打开睫状沟采用横折法植入折叠式人工晶状体,吸净Healon用0.1%卡巴胆碱缩瞳后冲净。B组切口制作同A组,但切口长度延长至5.5mm,虹膜粘连较紧密及位置欠佳者用钻石刀作2.5mm左右侧切口(透明角膜隧道切口),注入Healon于虹膜后间隙处,用玻璃体垂直剪或水平剪剪开分离虹膜后粘连后植入一体式人工晶状体。C组常规于角膜巩膜缘作6mm弧行切口,分离虹膜后粘连后植入人工晶状体,切口10/0尼龙线水密缝合。
后囊膜混浊者于术后2月行Nd:YAG后囊切开。
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