Marfan综合征晶状体半脱位的手术治疗探讨  

The clinic investigation about surgical treatment of lens subluxation in Marfan syndrome

作　　者：谢江斌[1] 陈跃真[1] 周凌[1] 

机构地区：[1]福建泉州市儿童医院泉州北京同仁眼科中心,泉州362000

出　　处：《中国实用眼科杂志》2005年第1期52-54,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的　探讨Marfan氏综合征晶状体半脱位手术治疗的安全有效方法。方法　采用小切口 ,晶状体干性吸除 ,保留晶状体后囊膜悬韧带 ,必要时干性玻璃体切除 ,折叠人工晶状体一襻睫状沟悬吊 ,另一襻及人工晶状体的光学部则置于保留的晶状体囊膜上的方法治疗 8例 16眼Marfan氏综合征晶状体严重半脱位 ,晶状体脱位范围均大于 180度 ,脱位一侧的晶状体边缘在自然状态下已达瞳孔区 ,最佳矫正视力 <0 3者 14眼 ,≥ 0 3者 2眼。结果　术后视力均较术前视力有明显的提高 ,术后视力 0 1～ 0 3者 6眼 ,0 4～ 0 9者 10眼。术后最佳矫正视力 0 1～ 0 3者 4眼 ,0 4～ 0 9者 12眼。正常瞳孔下人工晶状体正位 ,无一例发生偏斜。术后无角膜水肿 ,眼压高 ,脉络膜上腔出血 ,睫状体脉络膜脱离 ,玻璃体浑浊、增殖 ,视网膜脱离 ,黄斑囊样水肿等严重并发症的发生。术后瞳孔完全居中 14眼 ,轻度上移但不超过人工晶状体光学面边缘 2眼。结论　采用小切口 ,晶状体皮质干性吸除 ,保留晶状体后囊膜悬韧带 ,必要时干性玻璃体切除 ,折叠人工晶状体一襻睫状沟悬吊 ,另一襻及人工晶状体的光学部则置于保留的晶状体囊膜上的方法治疗Marfan氏综合征晶状体严重半脱位是一种安全、有效的方法。Objective To investigate the safe and effective methods of surgical treatment of lens subluxation in Marfan syndrome. Methods 16 eyes of 8 cases suffered from Marfan syndrome and severe lens subluxation were treated in this way that small incision,“dryly” lens aspiration,posterior capsule and zonule keeping,and “dryly” vitrectomy when necessary,one haptics of the foldable intraocular lens fixed at ciliary sulcus,another haptics and the optic part of the intraocular lens put onto the remained lens capsule.The range of lens subluxation in all these eyes was more than 180 degree,and all the lens edge of the side of lens subluxation came to the area of pupil in nature condition.Best-corrected vision of 14 eyes was less than 0 3,another 2 eyes was 0 3 or better. Results All cases got obviously better postoperative vision.After operation,the uncorrective vision of 6eyes ranged from 0 1 to 0 3,and 10 eyes ranged from 0 4 to 0 9.The best-corrected vision of 4 eyes ranged from 0 1 to 0 3,and 12 eyes ranged from 0 4 to 0 9.The pupil was normal,the intraocular lens was in the correct situation and no one was disclining.There were no severe complication as corneal edema,high intraocular pressure,expulsive suprachoroidal hemorrhage,detachment of ciliary body and uvea,vitreous opacity and proliferation,retinal detachment,cystoid degeneration of macula and so on.14 eyes showed pupil is perfectly placed in normal location,2eyes showed slig ly elevated but not beyond the edge of the optic part of the intraocular lens. Conclusions The technique of small incision,“dryly” lens aspiration,posterior capsule and capsular zonular network keeping,“dryly” vitrectomy when necessary,one haptics of the foldable intraocular lens fixed at ciliary sulcus,another haptics and the optic part of the intraocular lens put onto the remained lens capsule,can be safely and effectively used to treat lens subluxation in Marfan syndrome.

关 键 词：人工晶状体 囊膜 晶状体半脱位 治疗 瞳孔 保留 术后 光学 结论 方法 

分 类 号：R776.1[医药卫生—眼科] R779[医药卫生—临床医学]