前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性  

Efficacy and safety of the anterior chamber iris⁃claw intraocular lens implan⁃tation for the treatment of aphakic eyes without adequate capsular support

作　　者：刘彩娟 陈志敏 LIU Caijuan;CHEN Zhimin(Hebei Provincial Eye Hospital,Hebei Provincial Key Laboratory of Ophthalmology,Hebei Provincial Clinical Research Center for Eye Disea-ses,Xingtai 054000,Hebei Province,China)

机构地区：[1]河北省眼科医院,河北省眼科重点实验室,河北省眼部疾病临床医学研究中心,河北省邢台市054000

出　　处：《眼科新进展》2023年第5期393-396,共4页Recent Advances in Ophthalmology

基　　金：河北省科技厅民生科技项目(编号:192777103D)。

摘　　要：目的探讨前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性。方法选择河北省眼科医院白内障科2013年1月至2020年12月行晶状体摘出一期或二期植入前房型虹膜夹人工晶状体的患者53例62眼作为研究对象,62眼患者均为无足够囊膜支撑的无晶状体眼。术后随访3~9(5.68±1.29)年,收集患者手术前和末次随访裸眼视力(UCVA)、等效球镜度、眼压、前房深度、人工晶状体眼内固定位置及稳定性、角膜内皮细胞密度(ECD)、术后并发症等指标和临床信息。评价前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性。结果术前62眼UCVA(logMAR)为1.55±0.56,术后为0.23±0.15,术后UCVA较术前显著提高(t=18.64,P=0.00)。术后和末次随访UCVA(logMAR)(0.22±0.14)比较,差异无统计学意义(t=1.43,P=0.16),患者术后视力保持稳定。术后末次随访1眼等效球镜度为-1.25 D(为根据另一眼预留),等效球镜度-1.00~<-0.50 D者10眼,-0.50~+0.50 D者51眼。62眼术前眼压为(14.20±2.20)mmHg(1 kPa=7.5 mmHg),其中12眼于术后第1天开始出现眼压升高,达28.0~40.3 mmHg(主要原因是黏弹剂眼内残留并继发青光眼,经过降眼压处理后,眼压于3 d内恢复至正常范围);末次随访眼压为(13.92±2.10)mm⁃Hg,术前与末次随访眼压差异无统计学意义(t=0.25,P=0.90)。术前62眼ECD为(2826.3±489.8)个·mm^(-2),末次随访为(2474.3±397.6)个·mm^(-2),术前和末次随访ECD差异有统计学意义(t=6.82,P=0.00)。一期脱位晶状体或人工晶状体摘出联合前房型虹膜夹人工晶状体植入术后41眼ECD平均下降11.25%,二期前房型虹膜夹人工晶状体植入术后21眼ECD平均下降5.23%。术后共5眼ECD减少超过15%,均为开展手术早期的前5例患者。末次随访62眼前房深度为(2.40±0.32)mm,裂隙灯眼前节照相系统动态检查及眼前节OCT静态检查人工晶状体周边部和角膜内皮之Objective To explore the anterior chamber iris⁃claw intraocular lens implantation in the treatment of aphakic eyes without sufficient capsule support.Methods Totally 53 patients(62 eyes)who underwent an anterior chamber iris⁃claw intraocular lens implantation in the first or second stage of lens extraction from January 2013 to Decem⁃ber 2020 in the Cataract Department of Hebei Eye Hospital were included.All 62 eyes were aphakic eyes without adequate capsular support.The postoperative follow⁃up period was 3-9(5.68±1.29)years.Indicators and clinical information,in⁃cluding preoperative and last follow⁃up uncorrected visual acuity(UCVA),spherical equivalent(SE),intraocular pressure(IOP),anterior chamber depth,intraocular fixation position and stability of intraocular lenses,corneal endothelial cell density(ECD),postoperative complications,were collected.The efficacy and safety of anterior chamber iris⁃claw intraoc⁃ular lens implantation in the treatment of aphakic eyes without adequate capsular were evaluated.Results The preopera⁃tive and postoperative UCVA(logMAR)was respectively 1.55±0.56 and 0.23±0.15,and the latter was significantly higher than the former(t=18.64,P=0.00).There was no significant difference between the postoperative and last follow⁃up UC⁃VA(0.22±0.14)(t=1.43,P=0.16),and the postoperative visual acuity remained stable.At the last follow⁃up after sur⁃gery,1 eye had a SE of-1.25 D(reserved for the other eye),10 eyes with a SE of-1.00 D to-0.50 D,and 51 eyes with a SE of-0.50 to+0.50 D.The preoperative IOP of 62 eyes was(14.20±2.20)mmHg(1 kPa=7.5 mmHg).Among them,12 eyes began to have increased IOP at 1d after the surgery,reaching(28.0-40.3)mmHg.The main reason was the residual viscoelastic agent in the eye,which leads to secondary glaucoma.After IOP reduction treatment,the IOP returned to the normal range within 3d.The IOP at the last follow⁃up was(13.92±2.10)mmHg,and there was no significant differ⁃ence between the preoperative and last follow⁃up IOP(t=0.25,P=0.

关 键 词：无足够囊膜支撑的无晶状体眼 前房型虹膜夹人工晶状体植入术 安全性 

分 类 号：R776[医药卫生—眼科]