巩膜缝线固定后房型人工晶状体位置与视力预后的关系  

Observation on the correlation of visual outcome with the position of posterior chamber intraocular lenses after transscleral fixation

作　　者：罗怡[1] 卢奕[1] 杨晋[1] 陈倩[1] 王嘉健[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼科杂志》2008年第4期297-300,共4页Chinese Journal of Ophthalmology

摘　　要：目的观察无晶状体眼后房型巩膜缝线固定人工晶状体（IOL）的位置并探讨其与虹膜、房角结构的解剖关系及其与视力预后的关系。方法为回顾性系列病例研究。分析2004年1月至2006年6月间在我院行后房型IOL巩膜缝线固定术的患者32例（32只眼），应用超声活体显微镜观察眼前段组织与IOL位置的关系，并分为IOL偏斜组和无偏斜组；根据襻的位置分为双襻固定组和单襻固定组。术后随访6—18个月，观察视力变化情况。采用CMH校正的秩和检验对数据进行统计学分析。结果30只眼术后视力均较术前有不同程度提高，2只眼无变化。裂隙灯显微镜下观察IOL无明显倾斜或偏心。超声活体显微镜检查发现9只眼IOL位置倾斜，2只眼偏心。IOL位置有或无偏心倾斜的两组患者术后最佳矫正视力的差异有统计学意义（X^2=4．36，P〈0．05）。12只眼（37．5％）的IOL双襻位于睫状沟内，20只眼（62．5％）的IOL-襻位于睫状沟，另一襻分别在虹膜背（3．0％）、睫状体冠部（43．8％）、睫状体扁平部（9．4％）或玻璃体腔内（6．3％）。IOL双襻或单襻位于睫状沟固定，两组间视力的差异无统计学意义（X^2=0．26，P〉0．05）。结论后房型IOL巩膜缝线固定术现有的缝襻方式不能保证将双襻准确固定在睫状沟，IOL位置有无倾斜、偏心影响术后的最佳矫正视力，襻位置的变异与视力预后无明显关系。Objective To observe the location of posterior chamber intraocular lenses （PCIOL） after secondary transscleral fixation, to evaluate its impact on the stuctures of anterior segment and its correlation with visual outcome. Methods It was a retrospective case series, included 32 aphakic patients （32 eyes） with secondary transscleral fixation of PCIOL. Postoperatively, the accurate position of the lens and their relationship with adjacent structures were observed by ultrasound biomicroscopy （ UBM ）. The follow-up time period ranged from 6 to 18 months. Results Best-corrected visual acuity were improved postoperatively in 30 eyes while the other 2 eyes remained unchanged. No tilt or decentration of the lens was demonstrated by the slit lamp microscopy. While using UBM, optic tilt was found in 9 eyes and decentration in 2 eyes. The decentration and tilt of the lens correlated with visual outcome and was statistically significant （X^2=4.36,P 〈0.05）. In 12 eyes （37.5%）, both haptics were located in the sulcus. In 20 eyes （62. 5% ）, one haptic was located in the sulcus and the other one was in the back of the iris, pars plica （43.8%）, pars plana （9. 4% ） or vitreous cavity （6. 3%）. The different haptic locations were no correlated with visual outcome （ X^2 = 0. 26, P 〉 0. 05 ）. Conclusions The current suture technique for transscleral fixated PCIOLs can not ensure the proper anatomical outcome. The decentration and tilt of the lens correlate with the postoperative best corrected visual acuity. In our study, we could not find the correlation between the haptic location and visual outcome.

关 键 词：晶体 人工 晶体植入 眼内 显微镜检查 声学 视觉 预后 

分 类 号：R686[医药卫生—骨科学]