内窥镜引导人工晶状体固定对玻璃体切除术后无晶状体眼血-房水屏障功能的影响  

Disorder of the blood aqueous barrier after endoscope-guided intraocular lens transscleral fixation surgery

作　　者：刘丽华[1] 邹玉平[1] 张楚[1] 陈京霞[1] 邹秀兰[1] 林振德[2] 徐哲[1] 

机构地区：[1]广州军区广州总医院,510010 [2]中山大学中山眼科中心

出　　处：《中华眼外伤职业眼病杂志》2014年第8期561-564,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：国家自然科学基金（81371004）;广东省自然科学基金（2013010012045）;广东省科技计划项目（20118031800202）

摘　　要：目的探讨内窥镜引导人工晶状体（IOL）睫状钩缝线固定术对玻璃体切除术（PPV）后无晶状体眼的血一房水屏障功能的影响。方法38例（39只眼）人组。33只眼为接受PPV联合经平坦部晶状体切除（PPL）术后无晶状体眼，其中21只眼既往经受较严重的眼球挫伤或异物伤，3只眼为内源性眼内炎，9只眼为增生性糖尿病视网膜病变。其他6只眼为对照组，包括年龄相关性白内障晶状体超声乳化吸出及人工晶状体植入术3只眼，无内窥镜引导的常规人工晶状体囊袋内植入术3只眼。观察指标包括：术后视力、裂隙灯显微镜检查、UBM检查及激光前房闪光细胞检测仪检测IOL固定术前1d及术后1，7，30d房水闪光光度值等。结果术后最佳矫正视力0．2—1．0平均（0．6±0．21），优于术前的手动／30cm～0．2。无术中、术后出血等并发症。UBM显示术后1周常规IOL固定的1眼IOL轻度倾斜偏位。与超声乳化白内障摘除及IOL植入术相比，常规IOL固定术和内窥镜引导IOL固定术术后房水闪光值均显著增加，尤其是在术后1d，房水闪光值达到最高峰（F=216．2，214．1，P〈0．05）；并且，常规IOL固定术后房水闪光值高于内窥镜辅助IOL固定组（F=220．3，P〈0．05）；术后1周房水闪光值逐渐下降，至术后1个月时两组差异无统计学意义（F=205．0，P〉0．05）；与手术前1d房水闪光值相比，3种手术方式均有统计学意义（F=233．1，212．3，204．9，P〈0．05）。结论内窥镜引导的IOL固定对血一房水屏障（BAB）破坏相对轻微，并且恢复迅速。睫状沟与睫状体平坦部及虹膜根部的不同解剖学特点也是IOL固定位置不同引起BAB表现各异的重要原因之一。Objective To observe the function of the blood-aqueous barrier（BAB） after transscleral sulcus suture intraocular lens （IOL） fixation under endoscope guidance. Methods 39 eyes of 38 cases were enrolled in this study. Endoscope-assissted transscleral IOL fixation was performed in 33 eyes, of which 21 eyes were eyeball contusion or foreign body injury, 3 eyes were endogenous endophthalmitis, and 9 eyes were proliferative diabetic retinopathy. A foldable IOL was fixed in ciliary sulcus. 3 eyes underwent phacoemulsification combined with IOL implantation and 3 eyes with regular IOL fixation without endoscope guidance were taken as control. The observed items included post-surgery vision and slit-lamp microscopy. The BAB function was examined using the laser flare cell meter （ Kowa FC-2000 ） preoperatively and on postoperative day 1, 7, 30 by an independent examiner. The wileoxon test was used for data analysis. Results Postoperatively, the best corrected visual acuities of all cases ranged from 0.2 - 1.0 （0.6 ± 0.21 ）, were better than pre-operative hand movement/30 cm - 0.2. The UBM indicated the IOL of 1 eye dislocated slightly in regular IOL fixation group 1 week after surgery. The aqueous flare mean photon counts showed significant difference （ F = 216. 2, 214. 1, P 〈 0.05 ） in endoscope-assissted and regular lens fixation groups between phacoemulsification before surgery and after surgery especially on postoperative day 1, and highly significant difference between the regular lens fixation and the endoscope assissted on day 1 （ F= 220. 3, P 〈 0.05 ）, but no statistically significant difference （ F = 205. 0, P 〉 0.05 ） on postoperative day 50. Conclusion Endoscope-assissted transscleral IOL fixation has little effect on BAB function. The different anatomical characteristics of ciliary sulcus, pars plana and iris root may be crucial reasons for different BAB damage.

关 键 词：内窥镜引导 无晶状体眼 固定 晶状体 人工 屏障 血-房水 

分 类 号：R779.6[医药卫生—眼科]