改良囊袋张力环联合囊袋内人工晶状体植入治疗马方综合征晶状体不全脱位术后人工晶状体脱位的临床特征及手术治疗  

Clinical characteristics and surgical treatment of postoperative intraocular lens dislocation following modified capsular tension ring and intraocular lens implantation for ectopia lentis in Marfan syndrome

作　　者：陈泽旭 贾婉楠 王亚镭 申鑫 陈心姚 蒋永祥 CHEN Zexu;JIA Wanna;WANG Yalei;SHEN Xin;CHEN Xinyao;JIANG Yongxiang(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2024年第4期260-267,共8页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的观察接受改良囊袋张力环(MCTR)联合囊袋内人工晶状体(IOL)植入治疗的马方综合征(MFS)晶状体不全脱位患者术后IOL脱位的发生率,并总结接受IOL复位或取出术MFS患者的临床特征。方法通过随访观察2015年1月—2020年6月于我院同一手术医师行MCTR植入术且术后随访3年以上的MFS患者术后IOL脱位情况,计算其IOL脱位发生率。通过回顾分析我院同期就诊的MFS合并IOL脱位患者的临床资料,分析其临床特征和手术选择。结果本研究共纳入同一手术医师行MCTR植入术患者115例(192眼),大部分患者为儿童(80.21%,154/192),中位随访时间4年(四分位范围:3.50,4.67)。随访期间共出现MCTR-IOL复合体脱位3例(3眼),脱位发生率为1.56%(3/192),其中2例为不全脱位、1例为全脱位。3例患者均为成人,IOL脱位发生时间为术后2~3年,均无明显诱因,直接原因均为缝线断裂。同期在我院接受IOL复位或取出术的MFS患者共16例。IOL脱位最常见的直接原因是缝线断裂(62.50%,10/16)、其次是缝线或可植入式囊袋拉钩在巩膜层间出现滑动松脱(18.75%,3/16)。对于出现不全脱位的CTR或MCTR患者,通过缝线再次固定张力环或植入囊袋拉钩可实现IOL复位;MCTR脱位进入玻璃体腔的患者接受了MCTR取出和经巩膜后房型IOL缝线固定术;对于其他手术方式的IOL脱位患者,多数患者实现了脱位IOL复位术(54.55%,7/13),少数患者进行了IOL置换术(30.77%,4/13),2例IOL取出后未植入IOL。结论MCTR植入术是治疗MFS合并晶状体不全脱位的一种安全、有效的手术方式,IOL脱位是其罕见并发症。MFS患者术后定期随访十分必要,甚至需要终生随访,早期干预IOL脱位可以取得较好的疗效。Objective To report the incidence of intraocular lens(IOL)dislocation after modified capsular tension ring(MCTR)and IOL implantation in patients with Marfan syndrome(MFS)and ectopia lentis,and to report the clinical characteristics of MFS patients who underwent IOL repositioning or extraction in our hospital.Methods MFS patients who had undergone MCTR implantation by the same surgeon at our hospital from January 2015 to June 2020 were included.They were followed up for more than 3 years postoperatively to analyze the incidence of IOL dislocation.Patients with MFS and IOL dislocation who were treated at our hospital during the same period were retrospectively reviewed to analyze their clinical characteristics and surgical options.Results A total of 115 patients(192 eyes)who had undergone MCTR implantation by the same surgeon were included in this study,with the majority being children(80.21%,154/192).The median follow-up time was 4 years(IQR:3.50,4.67).During the follow-up period,there were 3 cases of MCTR-IOL complex dislocation,with 2 cases of subluxation and 1 case of total dislocation,resulting in an incidence rate of 1.56%(3/192).All of them were adults,and the occurrence of IOL dislocation was about 2 to 3 years postoperatively,with no obvious precipitating factors,and the direct cause was suture breakage.During the same period,a total of 16 MFS patients underwent IOL repositioning or extraction in our center.The most common direct cause of IOL dislocation was suture breakage(62.50%,10/16),followed by suture or intraocular bag hook slipping between the scleral stroma(18.75%,3/16).For patients with subluxation of CTR or MCTR,re-fixation of the tension ring with sutures or insertion of intraocular bag hooks could achieve IOL repositioning;patients with MCTR dislocation into the vitreous body underwent MCTR removal and scleral-fixated IOL implantation;for other patients previously receiving other IOL implantation methods,the majority underwent IOL reposition(54.55%,7/13),a minority underwent IOL exchange(30.77%

关 键 词：马方综合征 晶状体不全脱位 人工晶状体脱位 改良囊袋张力环 

分 类 号：R776[医药卫生—眼科]