外伤性晶状体不全脱位伴睫状体分离手术治疗2例  

Surgical management of traumatic subluxation of lens with cyclodialysis:a two-case series

作　　者：宁利 洪莹莹 荣先芳 季樱红 NING Li;HONG Yingying;RONG Xianfang;JI Yinghong(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》2025年第S1期28-33,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：病例一:40岁男性,因“左眼被磨光机砂轮片弹伤1个月余”入院。左眼最佳矫正视力:FC/30 cm(+3.00 DS/-1.25 DC×150°);眼压:8.7 mmHg(1 mmHg=0.133 kPa)。裂隙灯检查示左眼前房深浅不一、上方至颞侧周边前房消失,瞳孔散大、直径约5.5 mm,颞上虹膜后粘连,晶状体震颤、混浊C4N2P4伴上方至颞侧晶状体悬韧带断裂,视盘及视网膜水肿。超声生物显微镜(UBM)提示合并睫状体分离。诊断为左眼外伤性晶状体不全脱位、外伤性白内障、睫状体分离和视网膜挫伤。局部麻醉下行左眼前段玻璃体切除+Phaco+标准囊袋张力环(CTR)双针巩膜层间固定囊袋+人工晶状体(IOL)植入+睫状沟冷冻术。病例二:13岁女性,因“右眼被鞭炮炸伤3个月”就诊。伤后于当地医院诊断为“右眼睫状体分离”并行“外路睫状体缝合+前房成形术”。于我院就诊时,右眼最佳矫正视力:0.15(-1.00 DS);眼压:9.0 mmHg。裂隙灯检查示右眼结膜下缝线在位,前房玻璃体疝,虹膜、晶状体震颤伴不全脱位、晶状体混浊C3N2P5。UBM提示合并睫状体分离。诊断为右眼外伤性晶状体不全脱位、外伤性白内障、睫状体分离。全身麻醉下行右眼前段玻璃体切除+Phaco+CTR单针巩膜层间固定囊袋+IOL植入+CTR睫状沟内顶压术。讨论体会:外伤性晶状体不全脱位常合并睫状体分离,标准CTR巩膜层间固定囊袋术是治疗中重度晶状体不全脱位安全、有效的方式,兼具部分经内路缝合睫状体的效果。同时,个性化联合应用睫状沟冷冻与CTR睫状沟内顶压等方法可提高睫状体分离愈合率,以期在最小创伤下实现最佳疗效。Case 1:A 40-year-old male presented with a history of left ocular trauma due to hit by a grinding wheel fragment one month before.Best-corrected visual acuity(BCVA)of the left eye was FC/30 cm(+3.00 DS/-1.25 DC×150°),with an intraocular pressure(IOP)of 8.7 mmHg(1 mmHg=0.133 kPa).Slit-lamp examination revealed uneven anterior chamber depth,absent peripheral anterior chamber from the superior to temporal quadrants,a dilated pupil(approximately 5.5 mm in diameter),posterior synechia of the supero-temporal iris,lens tremor and opacity graded C4N2P4 according to the Lens Opacity Classification SystemⅢ(LOCSⅢ),and zonular dehiscence in the superotemporal quadrant.Fundoscopy demonstrated both optic disc and retinal edema.Ultrasound biomicroscopy(UBM)conformed cyclodialysis.Diagnoses included traumatic subluxation of lens,traumatic cataract,cyclodialysis,and retinal contusion in the left eye.The patient underwent left-eye phacoemulsification(Phaco)with intrascleral fixation of a standard capsular tension ring(CTR)within lens capsule using a double-needle technique,intraocular lens(IOL)implantation,and ciliary sulcus cryotherapy as well as anterior vitrectomy under local anesthesia.Case 2:A 13-year-old female presented with a history of“right ocular trauma caused by a firecracker explosion three months ago.”The patient had previously been diagnosed with“cyclodialysis in the right eye”at a local hospital and underwent“ciliary body suturing with anterior chamber reconstruction.”On presentation,BCVA of the right eye was 0.15(-1.00 DS),with IOP of 9.0 mmHg.Slit-lamp examination showed subconjunctival sutures in place,vitreous herniation into the anterior chamber,lens tremor and opacity graded C3N2P5 by LOCSIII.UBM confirmed cyclodialysis.Diagnoses included traumatic subluxation of lens,traumatic cataract,and cyclodialysis in the right eye.The patient underwent right-eye Phaco with intrascleral fixation of a standard CTR withing lens capsule using a single-needle technique,IOL implantation,CTR indentation of t

关 键 词：晶状体不全脱位 睫状体分离 标准囊袋张力环 睫状沟冷冻 

分 类 号：R68[医药卫生—骨科学]