先天性晶状体脱位患者术后人工晶状体脱位的原因及其危险因素分析  

Cause analysis and risk factors of intraocular lens dislocation for trans-scleral fixation after intraocular lens among congenital ectopia lentis patients

作　　者：马逸远 刘思源 靳光明[1] 郑丹莹[1] MA Yiyuan;LIU Siyuan;JIN Guangming;ZHENG Danying(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology Visual Science,Guangdong Provincial Clinical Research Center for Ocular Diseases,Guangzhou 510060,China)

机构地区：[1]中山大学中山眼科中心,眼病防治全国重点实验室,广东省眼科视觉科学重点实验室,广东省眼部疾病临床医学研究中心,广州510060

出　　处：《中国眼耳鼻喉科杂志》2024年第4期254-259,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：国家自然科学基金(81873673,81900841);广东省基础与应用基础研究(2021A1515011673,2022A1515011181);广州市基础研究计划市校(院)联合资助项目(SL2023A03J00514)。

摘　　要：目的探究先天性晶状体脱位(CEL)患者经巩膜人工晶状体(IOL)缝襻固定术后发生IOL脱位的原因及其危险因素分析。方法对123例(220眼)接受经巩膜IOL缝襻固定术的CEL患者进行回顾性分析,所有患者均接受全面的眼科检查,包括视力(VA)、眼压(IOP)及IOL位置等。采用广义估计方程分析评估CEL患者术后IOL脱位的危险因素。结果在随访期间(随访时间:36~94个月;中位随访时间:48个月),共有16例(17眼)术后发生IOL脱位,发生时间为术后2~78个月,平均为术后(38.2±23.3)个月。缝线断裂、缝线松脱、IOL襻断裂和术后眼外伤是导致IOL脱位的主要原因。广义估计方程分析显示,男性(OR:7.897,95%CI:1.025~60.859,P=0.047)、三片式IOL(AR40e,OR:3.344,95%CI:1.092~10.237,P=0.034)、眼外伤(OR:18.874,95%CI:2.271~156.849,P=0.007)及术后眼轴增长(OR:2.215,95%CI:1.022~4.800,P=0.044)是CEL患者术后IOL脱位的危险因素。结论IOL脱位是CEL患者经巩膜IOL缝襻固定术后的一种相对罕见但重要的远期并发症,其中缝线断裂和松脱为主要原因。因此,在缝线的选择和手术固定技术方面仍需要进一步研究和优化,以降低术后IOL脱位的风险。同时术后应加强随访,特别是对于男性患者,以便及时发现和处理可能出现的并发症。Objective To investigate the causes and risk factors of intraocular lens(IOL)dislocation in patients with congenital ectopia lentis(CEL)after trans-scleral fixation of intraocular lens.Methods A retrospective analysis of 123 patients(220 eyes)with CEL who had undergone trans-scleral fixation of intraocular lens was conducted.All patients underwent comprehensive ophthalmic examinations,including visual acuity(VA),intraocular pressure(IOP),and IOL position.Generalized estimating equations were conducted to evaluate the risk factors for postoperative IOL dislocation.Results During a median follow-up period of 48 months(range:36-94 months),16 patients(17 eyes)experienced IOL dislocation.The occurrence time ranged from 2 to 78 months after surgery,with an average of 38.2±23.3 months.The primary causes of IOL dislocation were suture breakage,suture loosening,IOL haptic breakage,and postoperative ocular trauma.The generalized estimating equation analysis indicated that males(OR:7.897,95%CI:1.025,60.859,P=0.047),three-piece IOL(AR40e)(OR:3.344,95%CI:1.092,10.237,P=0.034),eye trauma(OR:18.874,95%CI:2.271,156.849,P=0.007),and postoperative axial length increase(OR:2.215,95%CI:1.022,4.800,P=0.044)were risk factors for postoperative IOL dislocation.Conclusions IOL dislocation is a relatively rare but noteworthy late complication after trans-scleral fixation of intraocular lens in CEL patients,primarily caused by suture breakage and loosening.Therefore,further research and optimization of suture selection and surgical fixation techniques are warranted to reduce the risk of postoperative IOL dislocation.Enhanced postoperative follow-up,especially for male patients,is essential to timely detection and management of potential complications.

关 键 词：先天性晶状体脱位 经巩膜人工晶状体缝襻固定术 人工晶状体脱位 

分 类 号：R776[医药卫生—眼科]