有晶状体眼虹膜固定型人工晶状体植入术后再手术原因及安全性  

Corrective Surgery after Verisyse Iris-Supported Phakic Intraocular Lens Implantation

作　　者：代云海[1] 张静[1] 吴晓明[1] 荆丽丽 张晶[1] 谢立信[1] Yunhai Dai;Jing Zhang;Xiaoming Wu;Lili Jing;Jing Zhang;Lixin Xie(State Key Laboratory Cultivation Base,Shandong Provincial Key Lab of Ophthalmology,Shandong Eye Institute,Shandong Academy of Medical Sciences,Qingdao 266071,China)

机构地区：[1]山东省医学科学院,山东省眼科研究所青岛眼科医院,省部共建-山东省眼科学重点实验室,青岛266071

出　　处：《中华眼视光学与视觉科学杂志》2019年第2期141-146,共6页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金(81600721);山东省医学科学院医药卫生科技创新工程.

摘　　要：目的:探讨有晶状体眼虹膜固定型人工晶状体(PIOL)植入术后再手术原因以及长期眼内植入的安全性。方法:回顾性系列病例研究。选择2006年1月至2016年12月于青岛眼科医院白内障科接受有晶状体眼虹膜固定型PIOL植入术治疗高度近视后接受再次眼内手术治疗的患者11例(17眼)。分析再次手术的时间、方式以及原因。数据采用配对t检验进行分析。结果:再次手术的时间为PIOL植入术后6~108个月。12眼(12/17)因为外伤导致PIOL脱位于前房而接受了再次手术,该12眼再手术前角膜内皮细胞计数与植入术前比较,出现不同程度下降(t=5.968,P<0.001),其中1眼因脱位时间较长(1个月)而最终出现角膜内皮细胞功能失代偿。另有2眼(2/17)虽未出现PIOL脱位,但由于PIOL所夹虹膜较少或部分萎缩,PIOL位置松动,角膜内皮细胞非预期性明显减少,从而接受了人工晶状体再固定术;1眼(1/17)因为对侧眼PIOL脱位,角膜内皮细胞计数下降明显,患者出于恐慌,而决定手术取出PIOL;1例(1眼)患者(1/17)因为PIOL植入后出现视网膜脱离接受了视网膜复位手术,由于术后长期俯卧位,对侧眼(1/17)角膜内皮细胞计数下降明显(658个/mm2)而接受PIOL再固定手术。结论:外伤后PIOL脱位,PIOL松动后非预期性角膜内皮细胞计数下降是有晶状体眼虹膜固定型PIOL植入术后再次手术的主要原因。对于长期植入的患者需增加随访排查潜在的安全隐患。Objective:To discuss the long-term intraocular safety and the reasons for corrective surgery after the implantation of a Verisyse iris-supported phakic intraocular lens(Verisyse PIOL).Methods:The case records of 11 patients(17 eyes)who underwent corrective surgery after the implantation of a Verisyse PIOL for correction of high myopia from January 2006 to December 2016 at Shandong Eye Institute were reviewed in this study.The reasons,the time interval,and the procedure for the corrective surgery were recorded.Paired t-tests were used to analyze the data.Results:The longest time interval for the corrective surgery was 108 months while the shortest interval was 6 months.Twelve eyes(12/17)underwent corrective surgery because of PIOL dislocation due to trauma.Corneal endothelial cells in the 12 eyes showed a tendency to decrease significantly,and one of them eventually developed endothelial dysfunction due to the long period of dislocation(1 month).Except for trauma,two eyes(2/17)underwent corrective surgery because of partial iris atrophy,a loosening of the intraocular lens position,or a significant reduction in endothelial cell density(ECD).One eye(1/17)underwent PIOL extraction because the patient panicked about a decrease in ECD after PIOL dislocation in the contralateral eye.One eye(1/17)underwent corrective surgery because of retinal detachment,while the contralateral eye(1/17)underwent PIOL re-positioning because ECD decreased to 658/mm2,which had resulted from the long period of time the PIOL was in the prone position after intraocular surgery.Conclusions:The main reasons for corrective surgery after the implantation of a Verisyse PIOL is dislocation by trauma or an unexpected decline in ECD because the PIOL position loosened during the long follow-up period.Longer follow-up should be required in such patients to ensure their long-term safety.

关 键 词：退行性近视 有晶状体眼人工晶状体植入术 虹膜固定 

分 类 号：R779.6[医药卫生—眼科]