人工晶状体脱位合并玻璃体视网膜疾病的危险因素及手术疗效  

Risk factors and surgical outcomes for the concurrence of intraocular lens dislocation with vitreoretinal diseases

作　　者：熊思齐[1,2] 夏晓波 XIONG Siqi;XIA Xiaobo(Eye Center of Xiangya Hospital,Central South University,Changsha 410008;Hunan Key Laboratory of Ophthalmology,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院眼科中心,长沙410008 [2]眼科学湖南省重点实验室,长沙410008

出　　处：《中南大学学报（医学版）》2022年第7期881-887,共7页Journal of Central South University ：Medical Science

基　　金：国家重点研发计划(2020YFC2008205)。

摘　　要：目的:白内障术后晶状体悬韧带的变性和断裂可引起人工晶状体的脱位。同时,白内障手术后的炎症反应及玻璃体腔容积的增加会诱导或加速玻璃体后脱离的发生。玻璃体的后脱离与孔源性视网膜脱离、黄斑裂孔等多种玻璃体视网膜交界面疾病的发生有关。本研究旨在探讨发生人工晶状体脱位合并视网膜脱离、黄斑裂孔等玻璃体视网膜疾病的危险因素,评估玻璃体视网膜手术联合人工晶状体复位的手术疗效及并发症。方法:选取2014年1月至2020年12月中南大学湘雅医院眼科收治的诊断为孔源性视网膜脱离、外伤性黄斑裂孔、高度近视黄斑裂孔等玻璃体视网膜疾病,合并人工晶状体脱位的10例(10只眼)患者。纳入患者均接受玻璃体视网膜手术联合人工晶状体巩膜缝线固定术。分析人工晶状体脱位发生的时间及类型,以及术前及术后1年时的最佳矫正视力、眼内压、角膜内皮细胞密度和手术并发症。结果:纳入的10例患者中,4例为高度近视患者,4例为眼球钝挫伤患者,2例患者人工晶状体脱位发生于晶状体后囊膜切除过程中。高度近视和晶状体囊膜切除患者的人工晶状体脱位发生于玻璃体视网膜手术中,眼球钝挫伤患者人工晶状体脱位发生于玻璃体视网膜手术前。4例发生囊袋外脱位,6例发生人工晶状体囊袋复合体脱位。行玻璃体视网膜手术联合人工晶状体复位术后1年,患者的最佳矫正视力优于术前(1.13±0.45 vs1.79±0.39,P<0.001);患者的角膜内皮细胞密度小于术前[(1806.40±181.20)个/mm^(2)vs(1914.00±182.22)个/mm^(2),P<0.001];患者手术前后的眼内压差异无统计学意义(P=0.099)。手术并发症包括术后高眼内压及复发性视网膜脱离。结论:人工晶状体脱位可与玻璃体视网膜疾病同时发生。高度近视、眼球钝挫伤及晶状体囊膜切除可能是人工晶状体脱位发生的危险因素。通过玻璃体�Objective:The weakness and dialysis of lens zonule after cataract surgery may lead to dislocation of intraocular lens(IOL).It has been shown that cataract surgery could induce or aggravate posterior vitreous detachment(PVD)due to postoperative inflammation and increased volume of vitreous cavity.PVD is associated with the occurrence of several vitreoretinal diseases,such as rhegmatogenous retinal detachment and macular hole.This study aims to explore risk factors for dislocation of IOL concurring with vitreoretinal disease,such as retinal detachment and macular hole,and to evaluate the efficacy and complications of surgical intervention for these abnormalities concurrently.Methods:Ten patients(10 eyes)who diagnosed as rhegmatogenous retinal detachment,traumatic macular hole,high myopic macular hole,and combined with IOL dislocation at the Department of Ophthalmology of Xiangya Hospital from January 2004 to December2020 were enrolled.The patients received vitreoretinal surgery and reposition of IOL by scleral suturing.Medical records were reviewed to figure out the time and type of IOL dislocation.Preoperative and 1 year of postoperative best corrected visual acuity,intraocular pressure,corneal endothelial density,and complications of surgical management were analyzed.Results:Ten patients including 4 high myopia,4 ocular contusion,and 2 who experienced IOL dislocation during the posterior capsulotomy were included in this study.Coexistence of IOL dislocation and vitreoretinal abnormalities occurred in patients with high myopia,ocular contusion,and capsulotomy.IOL dislocation happened in the vitreoretinal surgery in patients with high myopia or intraoperative capsulotomy.IOL dislocation occurred preoperatively in patients with ocular contusion.IOL capsular bag complex dislocation and out-of-the-bag IOL dislocation were found in 4 and 6 patients,respectively.Surgical relocation of dropped IOL and repair of vitreoretinal disease improved the best corrected visual acuity from preoperative 1.79±0.39 to postoperative 1

关 键 词：人工晶状体脱位 视网膜脱离 黄斑裂孔 人工晶状体复位 

分 类 号：R779.6[医药卫生—眼科]