|
此外，值得一提的是，此次我们研究的549例患眼中，术后仅发现1例患者术后高眼压经保守治疗无法控制，以致最后不得不取出CTR眼压才得以降至正常。我们怀疑囊袋张力环植入术后出现高眼压的可能原因为：(1)术后前房内黏弹剂存留;(2)与人工晶状体襻不同，CTR与囊袋呈360°广泛接触，因此选择直径过大的张力环术后可能对睫状体产生刺激导致房水生成增加;(3)因为高度近视，术中注射入前房的黏弹剂可能通过松弛的悬韧带间隙进入后房，而当张力环植入后囊袋被拉紧，因此存留于后房的黏弹剂不易被吸出而导致眼压升高;(4)张力环对睫状体的刺激导致睫状体水肿使人工晶状体与睫状体的距离缩短，导致睫状环阻滞性青光眼。我们怀疑该患者房水排流受阻部位处于睫状环区域，即睫状突与晶状体赤道部或玻璃体前界膜的同位接触或粘连，完整增厚的后囊膜、前界膜、CTR和人工晶状体，可能作为一个屏障阻碍了房水向前流动。另外，此患者因高度近视，晶状体悬韧带松弛，可能使睫状突前旋，加上囊袋内植入囊袋张力环撑开囊袋，可能更加重了睫状突与晶状体赤道部的粘连，使房水前流受阻而逆流入玻璃体腔中，导致恶性青光眼发生[15]。
【参考文献】
1 Ciomu RJ, Osher RH. Endocapsular ring approach to the subfixed cataractous lens. J Cataract Refract Surg 1995;21(4):241245
2 Sun R. In vitro evaluation of the efficacy of the capsular tensionring for managing zonular dialysis in cataract surgery. Ophthalmic Surg Lasers 1998;29(6):502505
3 Burger J, Kreutzer T, Alge CS, et al. Capsular tension ringbased in vitro capsule opacification model. J Cataract Refract Surg 2008;34(7):11671172
4 Alió JL, Elkady B, Ortiz D, et al. Microincision multifocal intraocular lens with and without a capsular tension ring: optical quality and clinical outcomes. J Cataract Refract Surg 2008;34(9):14681475
5 马立威，张劲松，许军. 后发性白内障计算机图像定量分析系统建立与评价.眼科新进展2005;25(5):431434
6 Wei J, Jiang H. Novel stalegies in a prevention and treatment of posterior capsule opacification. Int J Ophthalmol(Guoji Yanke Zazhi) 2008;8(10):20902093
7 Jacob S, Agarwal A. Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis. J Cataract Refract Surg 2003;29:315321
8 Cionni RJ, Osher RH. Management of profound zonular dialysis or weakness with a new endocapsular ring designed for scleral fixation. J
Cataract Refract Surg 1998;24(10):12991306
9 Cionni RJ, Osher RH, Marques DM,et al. Modified capsular tension ring for patients with congenital loss of zonular support. J Cataract Refract
Surg 2003;29(9):16681673
10 Dick HB, Schwenn O, Pfeiffer N. Implantation of the modified endocapsular bending ring in pediatric cataract surgery using a viscoadaptive viscoelastic agent. J Cataract Refract Surg 1999;25:14321436
11 DEliseo D, Pastena B, Longanesi L, et al. Prevention of posterior capsule opacification using capsular tension ring for zonular defects in cataract surgery. Eur J Ophthalmol 2003;13:151154
12 黎晓新,王景昭.玻璃体、视网膜手术学.北京:人民卫生出版社 2000:8
13 Colin J, Robinet A, Cochener B. Retinal detachment after clear lens extraction for high myopia:sevenyear followup. Ophthalmology 1999;106(12):22812285
14 权彦龙，周爱意，熊全臣.高度近视眼白内障术后并发视网膜脱离的临床分析.眼科学报2008;24(1):4447
15 彭华琮.人工晶状体及囊袋张力环植入眼恶性青光眼l例.国际眼科杂志2007;7(6):17751776 上一页 [1] [2] |
