【摘要】目的：探讨虹膜缝线固定后房型折叠式人工晶状体植入治疗无囊膜眼的可行性和有效性。方法：无囊膜眼15眼，采用经3.2mm角膜缘切口或透明角膜切口，植入后房型三片式折叠式人工晶状体（Alcon MA60BM），双襻用100聚丙烯缝线缝合固定于虹膜中周部，观察术中植入情况和术后视力、眼前段及眼压等情况。结果：所有病例均顺利植入人工晶状体，3例术中出现前房出血。术后随访3～15mo，视力均有不同程度提高，人工晶状体位置正常，无严重术后并发症发生。结论：虹膜缝线固定后房型人工晶状体植入治疗无囊膜眼是可行和有效的，长期的并发症有待进一步观察。
【关键词】 无囊膜眼；虹膜缝线固定；人工晶状体
Implantation of irissutured foldable posterior chamber intraocular lens in the absence of capsular support
JinXian He, XianJun Liang, YingJie Lin, GuoPei Li, Zhi Huang
1Department of Ophthalmology, the Affiliated Foshan Hospital of Sun YatSen University, Foshan 528000, Guangdong Province, China;2Department of Ophthalmology, Traditional Chinese Medical College of Foshan, Foshan 528000, Guangdong Province, China
Correspondence to: XianJun Liang. Department of Ophthalmology, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China. [email protected]
AbstractAIM: To evaluate the application and effect of implantation of posterior chamber foldable threepiece intraocular lens (IOL) sutured in iris of eyes lacking adequate posterior capsular support. METHODS: In 15 cases absent of capsular support, 3。2mm incision was made in limber or transparent cornea, and foldable threepiece IOL (Alcon MA60) was implanted in posterior chamber with both loops sutured in iris by 100 polypropylene. The procedure of IOL implantation, the postoperative visual acuity, anterior segment and IOP were observed. RESULTS: All cases were implanted the IOLs successfully. Three cases had hyphema during the operation. All cases were followed up for 3 to 15months. The visual acuity was increased to different degrees. The pupils were round or approximately round. And all the IOLs were proper places. No serious complications were found.CONCLUSION: Implantation of foldable threepiece IOL with fixed loops sutured in iris in posterior chamber of noncapsular eyes is applicable and effective. Longterm complications are to be observed.
KEYWORDS: absence of capsular support; irissutured; intraocular lens
0引言
无囊膜眼在眼科临床实践中常见到，它多见于白内障囊内摘除术后，白内障囊外摘除术中、后囊膜破裂，晶状体悬韧带大范围的松弛，以及外伤性白内障，晶状体脱位术后，玻璃体切除联合晶状体切除术后等。由于缺乏后囊膜支持，无法按常规施行后房型人工晶状体植入手术，对此我们采取虹膜缝线固定法行后房型三片式折叠人工晶状体植入术，现已完成13例(15眼)，均获得满意效果，现报告如下。
1对象和方法
1.1对象
本组资料无囊膜眼15眼，其中男8例（9眼），女5例（6眼），右眼9例，左眼6例；年龄18~65（平均47。3）岁。眼外伤术后4眼（其中晶状体切除联合前段玻璃体切除术后3眼，晶状体切除联合后段玻璃体切除术后1眼），白内障囊内摘除术后6眼，晶状体脱位3眼，复杂性视网膜脱离玻璃体切除术后2眼。
1.2方法
病例均为无囊膜眼二期人工晶状体植入。术前10g/L Pilocarpine缩瞳；做上方3.2mm的透明角膜切口或角膜缘切口，下方、鼻、颞侧分别做辅助切口；前房内注入粘弹剂。对于已经行玻璃体切除术后的无晶状体眼，先行睫状体扁平部灌注，再做角膜切口。将三片式折叠人工晶状体（Alcon MA60BM），以横夹式折叠，经3.2mm切口植入眼内，在人工晶状体刚展开时，经下方切口伸入显微虹膜恢复器于人工晶状体光学部正下方，支撑其光学部，使整个人工晶状体光学部夹持于瞳孔区，双襻位于虹膜后方。取出显微虹膜恢复器，用100聚丙烯缝线，分别经颞、鼻侧角膜切口进针，在晶状体襻附近穿过虹膜中周部，至后房绕过晶状体襻，经该襻的对侧穿出虹膜返回前房，穿过周边部角膜出针；调整人工晶状体位置使其居中，用晶状体定位钩经进针角膜切口进入前房，钩回出针侧缝线，用此线在眼外常规打结，滑入前房拉紧，如此重复两次，即形成牢固的线结将襻固定于虹膜后。用显微剪自眼内、外分别剪断缝线。以晶状体定位钩将人工晶状体光学部推至虹膜后。清除前房内粘弹剂，角膜切口水密，不缝合。已行玻璃体切除术后患眼拔除灌注管，缝合巩膜及结膜切口[1]。术后常规皮质类固醇及抗生素点眼，全身用皮质类固醇及抗生素静脉滴注,复方托吡卡胺活动瞳孔。观察术后视力、眼前段及眼压等情况。
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