改良Yamane法无缝线人工晶状体巩膜层间固定术的疗效观察  

Efficacy of sutureless intrascleral intraocular lens fixation with the modified Yamane technique

作　　者：陈燕云 周丹 李蕾 李栋军 何雷 于洁 史翔宇 Chen Yanyun;Zhou Dan;Li Lei;Li Dongjun;He Lei;Yu Jie;Shi Xiangyu(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心、北京市眼科研究所、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼科杂志》2024年第6期503-510,共8页Chinese Journal of Ophthalmology

摘　　要：目的探讨改良Yamane法无缝线人工晶状体(IOL)巩膜层间固定术的临床疗效。方法回顾性病例系列研究。连续收集2022年1月至2023年9月在首都医科大学附属北京同仁医院北京同仁眼科中心行改良Yamane法无缝线IOL巩膜层间固定术的患者资料纳入研究。患者于术前及术后1 d、3 d、7 d、1个月、3个月等时间点检查裸眼视力和最佳矫正视力(BCVA)并记录为最小分辨角的对数, 检查屈光度数和眼压, 行裂隙灯显微镜检查眼前节、眼底检查、前节相干光层析成像术(OCT)和后节OCT。记录术中及术后眼部并发症。结果最终纳入53例(53只眼)患者的资料, 其中男性40例, 女性13例;年龄为60(49, 68)岁。伴有外伤史的患眼占比22.6%(12/53)。术中发生玻璃体出血1只眼(1.9%)。所有术眼术后1周均未发生低眼压、前房内炎性反应和瞳孔异常。术后随访时间为(8.0±3.3)个月(3~16个月), 随访中均未出现IOL瞳孔夹持、IOL再脱位、IOL襻暴露。术前和术后角膜内皮细胞计数为(2 236±704)和(1 964±628)个/mm2, 差异有统计学意义(P<0.001)。术前、术后1个月、术后3个月及末次随访的裸眼视力分别为1.53±0.75、0.18±0.17、0.15±0.14、0.14±0.13, 组内比较差异有统计学意义(P<0.001), 其中术后1个月裸眼视力分别与术后3个月、末次随访相比的差异均有统计学意义(均P<0.05)。术后1和3个月裸眼视力≤0.1的患眼分别占50.9%(27/53)和56.6%(30/53)。术前、术后1个月、术后3个月及末次随访的BCVA分别为0.25±0.21、0.03±0.06、0.02±0.06、0.02±0.06, 组内比较差异有统计学意义(P<0.001), 其中术后1个月BCVA分别与术后3个月、末次随访相比的差异均无统计学意义(均P>0.05)。术后1和3个月BCVA≤0的患眼占比分别为81.1%(43/53)和83.0%(44/53)。术后1 个月IOL倾斜度为(5.18±2.60)°, 术后3个月则为(5.08±2.48)°, IOL离心度分别为(0.35±0.24)和(0.32±0.24)mm, 差异均无统计学意义Objective To evaluate the efficacy of sutureless intrascleral intraocular lens(IOL)fixation with the modified Yamane technique.Methods It was a retrospective case series study.Patients undergoing sutureless intrascleral IOL fixation with the modified Yamane technique were included at Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University from January 2022 to September 2023.Uncorrected visual acuity(UCVA)and best-corrected visual acuity(BCVA),recorded as the logarithm of the minimum angle of resolution(logMAR),were measured before surgery and at 1 day,3 days,1 week,1 month,and 3 months postoperatively.Refractive error and intraocular pressure were also checked.Anterior segment examination with a slit lamp microscope,fundus examination,anterior segment and posterior segment optical coherence tomography were performed.Intraoperative and postoperative ocular complications were documented.Results A total of 53 patients(53 eyes)were included in this study,comprising 40 males and 13 females,with a median age of 60(49,68)years.Among them,the proportion of a history of trauma was 22.6%(12/53).There was 1 eye with intraoperative vitreous hemorrhage(1.9%).All eyes had no obvious hypotony,no obvious inflammation in the anterior chamber,and no pupillary abnormalities at 1 week after surgery.The mean follow-up time was(8.0±3.3)months(range,3 to 16 months).There was no iris capture,re-dislocation,or haptic exposure of the IOL during the follow-up.The corneal endothelial cell density was(2236±704)cells/mm2 preoperatively and(1964±628)cells/mm2 at 1 month,with significant difference(P<0.001).The UCVA(logMAR)was 1.53±0.75 preoperatively,0.18±0.17 at 1 month,0.15±0.14 at 3 months,and 0.14±0.13 at the final visit(P<0.001).The UCVA(logMAR)at 1 month was significantly different from that at 3 months and the final visit(both P<0.05).At 1 month,50.9%(27/53)of the eyes had an UCVA(logMAR)≤0.1,and the rate was 56.6%(30/53)at 3 months.The BCVA(logMAR)was 0.25±0.21,0.03±0.06,0.02±0.06,and 0.02±0.06 befor

关 键 词：晶体 人工 巩膜 无缝线外科手术 视敏度 预后 

分 类 号：R779.6[医药卫生—眼科]