【摘要】 目的：评价玻璃体腔内超声乳化联合玻璃体切除治疗晶状体全脱位所致青光眼的疗效。方法：选取200711/201003对16例16眼因眼钝挫伤或白内障摘除术中后囊破裂晶状体核全脱位于玻璃体腔导致眼压升高的患者，采用标准睫状体扁平部闭合式三切口，先行全玻璃体切除术，再采用去硅胶袖套的超声乳化头乳化摘除脱位的晶状体，术后观察视力、眼压、视网膜、巩膜伤口等恢复情况。结果：所有晶状体均成功摘除，没有发生严重的并发症。视网膜、巩膜伤口无明显损害。术后视力提高到指数/眼前者2眼，0.1～0.3者7眼，>0.3者5眼，其余2眼保持不变。术后眼压15～20mmHg者14眼，>21mmHg者2眼，经滴降眼压眼液后，眼压降至<20mmHg。结论：玻璃体腔内超声乳化联合玻璃体切除治疗晶状体全脱位所致青光眼，具有眼内组织损伤小，方便，快捷，不需要应用重水的特点。超声乳化头完全可以代替超声粉碎头用于晶状体脱位于玻璃体腔的治疗。
【关键词】 晶状体脱位;超声乳化;玻璃体切除;青光眼
Removal dislocated lenses in vitreous cavity by intravitreal phacoemulsification
DaLing Xu, Yan Chen, Ming Huo
Department of Ophthalmology, Yichang Central Peoples Hospital, Yichang 443003, Hubei Province, China
Correspondence to: Yan Chen. Department of Ophthalmology, Yichang Central Peoples Hospital, Yichang 443003, Hubei Province, China. [email protected]
Received:20100715 Accepted:20100816
Abstract
AIM: To evaluate the effect of treating the glaucoma with phacoemulsification replacing phacofragmentation without perfluorocarbon liquid to remove the dislocated lens in vitreous cavity.
METHODS: Between November 2007 and March 2010, a series glaucomatous cases of 16 patients 16 eyes with posterior dislocation lens because of ocular trauma or cataract surgery were studied retrospectively. The total vitrectomy combined with intravitreal phacoemulsification devoid of the silicone sleeve was used to remove dislocation of the lens. The main outcome measures were visual acuity, intraocular pressure, retina and sclera healing postoperatively.
RESULTS: All dislocated lenses were successfully removed. There was no retinal detachment, retinal hemorrhage and sclera burning. No complications occurred during phacoemulsification. After operation, Visual acuity was counting fingers in 2 eyes, 0.10.3 in 7 eyes, more than 0.3 in 5 eyes and was unchanged in 2 eyes. The postoperative intraoclar pressure was located between 1520mmHg in 14 eyes and lowered to mormal range in another two eyes using antiglaucoma medical drops.
CONCLUSION: The conventional phacoemulsification probe devoid of the silicone sleeve can be used to remove the dislocaed lens of vitreous cavity in vitrectomy surgery. This technique has minor injury, convenience and short time and doesn’t need the perfluorocarbon injection. It is preferred to treat the glaucoma due to the dislocation of lens.
KEYWORDS: dislocated lens; phacoemulsification; vitrectomy; glaucoma
Xu DL, Chen Y, Huo M. Removal dislocated lenses in vitreous cavity by intravitreal phacoemulsification. Int J Ophthalmol(Guoji
Yanke Zazhi) 2010;10(9):17631764
因眼外伤或白内障手术中后囊破裂导致晶状体全脱位于玻璃体很常见，除引起视力障碍和部分视野遮挡外，最常见的并发症是青光眼，目前最有效的治疗方法是手术治疗。但常规青光眼滤过手术效果不理想[1]，最佳选择是标准三通道闭合式玻璃体手术切除脱位的晶状体。目前对于晶状体全脱位的处理，主要是借助玻璃体切除机的超声粉碎技术或在使用全氟化碳(重水)的情况下从前段取除[2]。我们在玻璃体切除的基础上，采用Alcon LEGACY 20000超声乳化头代替超声粉碎头治疗了16例晶状体全脱位所致的青光眼，而且未使用全氟化碳(重水)，取得了较好的治疗效果，现报告如下。
1对象和方法
1.1对象
收集200711/201003收住我院晶状体全脱位于玻璃体腔的病例16例16眼，其中男12眼，女4眼;年龄25～72(平均45.5)岁。入院时眼压28～56mmHg，入院时患眼视力(矫正视力)<0.1者10眼，0.1～0.2者4眼，视力>0.2者2眼。术前应用1～3种降眼压药物，新鲜挫伤病例联合应用激素和抗生素。
1.2方法
常规行球后和球结膜下浸润麻醉后，行标准睫状体扁平部闭合式三切口(角膜缘后3mm)。先行眼内玻璃体及积血全切除，处理好巩膜穿刺孔，充分游离晶状体。采用美国Alcon LEGACY 20000超声乳化仪，超声乳化头喇叭形ABS细针头(直径0.84mm);乳化参数：吸力350mmHg，能量60%，流量28cc/min;脉冲超声乳化模式，频率在15次/s左右。将去硅胶袖套的ABS针头经巩膜穿刺孔入玻璃体腔，连接灌注管和抽吸管;用乳化针头高负压吸住并提起晶状体远离视网膜至玻璃体腔中前部，在导光纤维头辅助下，行晶状体超声乳化。如晶状体核脱离超声乳化头，即重复上述操作过程。对于残留的晶状体皮质可以采用玻璃体切除头去除掉。6眼因行超声乳化术中后囊破裂晶状体核脱入玻璃体腔者给予行Ⅰ期聚丙烯缝线睫状沟人工晶状体悬吊固定术;其余患者随访>3mo，无视网膜脱离矫正视力>0.1者，眼压正常可进行Ⅱ期人工晶状体悬吊固定植入。术后常规行抗生素、激素局部及全身治疗，加压包扎等对症处理。术后1wk左右出院。
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