晶状体后脱位的23G微创玻璃体切割术应用价值  

The 23-gauge micro-invasive vitrectomy in treating posteriorly dislocated crystal lens

作　　者：吴敏[1] 和丹[1] 胡竹林[1] 李云琴[1] 

机构地区：[1]云南省第二人民医院眼科昆明医科大学第四附属医院眼科,650021

出　　处：《中国实用眼科杂志》2015年第10期1154-1156,共3页Chinese Journal of Practical Ophthalmology

基　　金：云南省教育厅科学研究基金项目（2011C079）;云南省卫生科技计划项目（2012WS0109）

摘　　要：目的探讨23G微创玻璃体切割手术在晶状体后脱位中的应用价值。方法对2011年1月至2013年12月间在云南省第二人民医院眼科就诊的晶状体后脱位病例43例（43只眼），根据术前检查晶状体核的情况（Emery分级系统）和患者年龄不同，分为A组：23GPPV联合超声粉碎者15例；B组：23GPPV手术26例；C组：23GPPV联合经角膜缘晶状体娩出2例。术后3个月行Ⅱ期巩膜缝线固定人工晶状体植入术。结果术后随访12～18月，平均随访（14．5±1．1）月。A、B、C三组末次随访的BCVA分别与术前视力相比，差异有统计学意义（t=5．981、6．102、5．662，P〈0．001）。2例（2只眼）角膜水肿消退后检查房角发现房角后退，行滤过手术后眼压降至正常。手术方案为B组的病例中，有1例术中清除玻璃体积血后发现晶状体核Ⅲ级，改为A组方案。术后并发症2例角膜水肿，1例脉络膜脱离，药物治疗后消失。结论利用23G微创玻璃体切割系统应用不同手术方案来治疗晶状体后脱位是安全有效的。Objective To discuss the value of 23-gauge micro-invasive vitrectomy in treating posteriorly dislocated crystal lens. Methods Forty-three cases （43 eyes） of posteriorly dislocated crystal lens were treated in our hospital from January 2011 to December 2013. According to preoperative evaluation of lens nucleus （Emery classification system） and patients＇ age, the patients were divided into three groups： Group A： 15 cases using 23-gauge PPV combined with phacofragmentation; group B： 26 cases using 23-gauge PPV; group C： 2 cases using 23-gauge PPV combined with nucleus extraction via corneal-scleral incision. The intraocular lens transscleral fixation was performed three months later. Results The follow-up duration was 12 to 18 months, （14.5±1.1） months on average. The BCVA at last visit was statistically significant better than pre-operative BCVA in group A, B and C （t =5.981, 6.102, 5.662, P value〈0.001）. Two cases were detected with angle recession after corneal edema resolve. The intraocular pressure in these two cases returned to normal after the filtration surgery. One case in group B was found with grade III nucleus after removal of vitreous hemorrhage. Thus the surgical approach was shifted to Group A. There were 2 cases of corneal edema and 1 case of choriodal detachment post-operatively, which were treated medically. Conclusions Dif- ferent surgical plans using 23-gauge micro-invasive vitrectomy are effective and safe in treating posteriorly dislocated crystal lens.

关 键 词：晶状体后脱位 23G 玻璃体切割手术 

分 类 号：R779.6[医药卫生—眼科]