人工晶状体脱位黄斑囊样水肿患者玻璃体切除人工晶状体悬吊及球后注射曲安奈德的效果观察  

Efficacy of retrobulbar triamcinolone acetonide after vitrectomy combined with intraocular lens fixation for intraocular lens dislocation with cystoid macular edema

作　　者：陈燕云[1] 周丹[1] 李蕾[1] 何雷[1] 于洁[1] 史翔宇[1] Chen Yanyun;Zhou Dan;Li Lei;He Lei;Yu Jie;Shi Xiangyu(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China)

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

出　　处：《眼科》2024年第4期301-306,共6页Ophthalmology in China

摘　　要：目的探讨人工晶状体(IOL)脱位伴黄斑囊样水肿(CME)患者行玻璃体切除术(PPV)联合IOL悬吊及球后注射曲安奈德(TA)的治疗效果。设计回顾性病例系列。研究对象2020年1月至2024年1月北京同仁医院IOL脱位伴CME患者19例(19眼)。方法所有患者治疗前均行常规眼科检查,包括裸眼视力(UCVA)和最佳矫正视力(BCVA)、眼压、眼底检查、荧光素眼底血管造影、OCT并测量黄斑中心凹视网膜厚度(CMT)。所有患眼的手术方式均为PPV联合IOL悬吊术,术毕立即球后注射TA(20 mg)。随访至少3个月。主要指标BCVA、眼压、CMT、CME复发情况、并发症。结果所有患者术后随访平均为(7.05±3.26)个月(4~15个月)。患眼术后1、3个月、末次随访BCVA(LogMAR)分别为(0.11±0.09)、(0.07±0.13)、(0.09±0.19),与术前(0.52±0.21)相比均显著降低(P均<0.001)。患眼术后1、3个月、末次随访眼压分别为(18.06±3.11)mmHg、(17.61±2.17)mmHg、(17.00±2.93)mmHg,与术前眼压(16.94±3.42)mmHg相比较,均无显著差异。所有患眼术后1、3个月、末次随访CMT分别为(289.84±37.30)μm、(295.16±107.75)μm、(300.53±125.37)μm,与术前CMT(451.47±140.71)μm相比均下降(均P<0.001)。15.8%(3/19例)患眼的CME在随访中出现过至少1次复发。所有患眼在治疗及随访过程中均无玻璃体出血、视网膜脱离、感染性眼内炎、IOL再脱位等严重并发症。术后1个月高眼压发生率为5.3%(1/19例),术后3个月时眼压恢复正常。结论PPV联合IOL悬吊术及球后注射TA是治疗IOL脱位伴CME的一种安全、有效的方法。Objective To explore the effect of retrobulbar triamcinolone acetonide(TA)after pars planavitrectomy(PPV)combined with intraocular lens(IOL)fixation for IOL dislocation with cystoid macular edema(CME).Design Retrospective case series.Participants 19 patients(19 eyes)with IOL dislocation and CME were included from January 2020 to January 2024 in Beijing Tongren Hospital.Methods All cases underwent routine ophthalmic examination before surgery,including uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA),intraocular pressure(IOP),fundus examination,fundus fluorescein angiography,OCT and central macular thickness(CMT)measurement.The surgical methods for all included eyes were vitrectomy combined with IOL fixation,and TA(20 mg)retrobulbar injection after the surgery immediately.All patients underwent routine postoperative follow-up at 1,3,7 days,1,3 months and above after surgery.Main Outcome Measures BCVA,IOP,CMT,recurrence of CME,and complications.Results The postoperative follow-up time was(7.05±3.26)months(4-15 months).BCVA(LogMAR)at 1 month,3 months after surgery,and final follow-up was(0.11±0.09),(0.07±0.13),(0.09±0.19),compared with the preoperative BCVA(LogMAR)(0.52±0.21),which was all significantly decreased(all P<0.001).The IOP at 1 month,3 months after surgery,and final follow-up was(18.06±3.11)mmHg,(17.61±2.17)mmHg,(17.00±2.93)mmHg,compared with the preoperative IOP(16.94±3.42)mmHg,which was all without significant difference.The CMT at 1 month,3 months after surgery,and the last follow-up was(289.84±37.30)μm,(295.16±107.75)μm,(300.53±125.37)μm,compared with that before surgery(451.47±140.71)μm,which was all significantly decreased(all P<0.001).The CME in 15.8%(3/19 cases)reappeared at least 1 time during the follow-up.No serious complications such as vitreous hemorrhage,retinal detachment,infectious endophthalmitis,and IOL redislocation occurred in all the eyes during surgery and follow-up.The incidence of intraocular hypertension was 5.3%(1/19 cases)1 month after surge

关 键 词：人工晶状体脱位 黄斑囊样水肿 曲安奈德 

分 类 号：R779.6[医药卫生—眼科]