两种术式固定后房型人工晶状体治疗晶状体脱位的疗效  

Efficacy of two kinds of posterior chamber intraocular lens fixation in the treatment of lens dislocation

作　　者：马铭浩 李伟[1,2] 苏锐锋 苏畅[1,2] 高冰 陈兴玉[1,2] Ming-Hao Ma;Wei Li;Rui-Feng Su;Chang Su;Bing Gao;Xing-Yu Chen(Chengde Medical University,Chengde 067000,Hebei Province,China;Department of Ophthalmology,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei Province,China)

机构地区：[1]承德医学院,河北省承德市067000 [2]承德医学院附属医院眼科,河北省承德市067000

出　　处：《国际眼科杂志》2023年第6期958-962,共5页International Eye Science

摘　　要：目的:对比25G玻璃体切割联合人工晶状体经睫状沟巩膜缝线固定术和无缝线巩膜隧道层间固定术治疗晶状体完全脱位的疗效。方法:回顾性病例对照研究。选取2015-05/2021-09在我院确诊为晶状体完全脱位于玻璃体腔的患者40例40眼,其中行25G玻璃体切割联合人工晶状体经睫状沟巩膜缝线固定术者21眼(缝线组),行25G玻璃体切割联合人工晶状体无缝线巩膜隧道层间固定术者19眼(无缝线组)。随访至术后3mo,观察两组患者手术时间、最佳矫正视力(BCVA)、角膜内皮细胞计数(CECC)、中央角膜厚度(CCT)及术后并发症情况。结果:无缝线组手术用时显著短于缝线组(31.79±6.01min vs 45.38±8.04min,P<0.001)。两组患者术后BCVA均较术前显著改善(均P<0.05),术后1wk无缝线组BCVA(LogMAR)显著优于缝线组(0.32±0.14 vs 0.57±0.25,P<0.001)。术后3mo,两组患者CECC均低于术前(均P<0.01)。缝线组术后1wk CCT大于术前和术后3mo(均P<0.01),无缝线组手术前后CCT无显著变化。随访期间,无缝线组并发症总发生率低于缝线组(26%vs 38%,P>0.05)。结论:25G玻璃体切割联合人工晶状体无缝线巩膜隧道层间固定术治疗晶状体完全脱位手术时间短,术后视力提升快,术后并发症少。AIM:To compare the efficacy of 25-gauge(25G)vitrectomy combined with intraocular lens transciliary sulcus scleral suture fixation and sutureless scleral tunnel interlamellar fixation in the treatment of complete lens dislocation.METHODS:Retrospective case-control study.A total of 40 patients(40 eyes)diagnosed with complete lens luxation in the vitreous cavity in our hospital from May 2015 to September 2021 were selected,among which 21 eyes(suture group)underwent 25G vitrectomy combined with intraocular lens fixation via ciliary sulci scleral suture,and 19 eyes(sutureless group)underwent 25G vitrectomy combined with interlamellar scleral tunnel fixation of intraocular lens.The patients in both groups were followed up until 3mo after surgery to observe the operative time,best corrected visual acuity(BCVA),corneal endothelial cell count(CECC),central corneal thickness(CCT)and postoperative complications.RESULTS:The operation time was significantly shorter in the sutureless group than in the suture group(31.79±6.01min vs.45.38±8.04min,P<0.001).BCVA in both groups was significantly improved after surgery(all P<0.05),and the BCVA(LogMAR)at 1wk after operation in the sutureless group was significantly better than that in the suture group(0.32±0.14 vs.0.57±0.25,P<0.001).At 3mo after surgery,CECC in both groups was lower than that before surgery(all P<0.01).The CCT at 1wk after operation in the suture group was greater than that before operation and at 3mo after operation(all P<0.01),and there was no significant change in CCT before and after surgery in the sutureless group.During follow-up period,the total complication rate in the sutureless group was lower than that in the suture group(26%vs.38%,P>0.05).CONCLUSION:25G vitrectomy combined with intraocular lens sutureless scleral tunnel interlamellar fixation in the treatment of complete lens luxation has shorter operation time,faster postoperative visual acuity improvement and fewer postoperative complications.

关 键 词：晶状体脱位 25G玻璃体切割术 人工晶状体 睫状沟巩膜缝线固定术 无缝线巩膜隧道层间固定术 

分 类 号：R779.6[医药卫生—眼科]