中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2011年
1期
45-49
,共5页
晶状体半脱位%白内障%晶体囊%超声乳化白内障吸除术
晶狀體半脫位%白內障%晶體囊%超聲乳化白內障吸除術
정상체반탈위%백내장%정체낭%초성유화백내장흡제술
Lens subluxation%Cataract%Lens capsule,crystalline%Phacoemulsification
目的 探讨虹膜拉钩辅助在伴不全脱位白内障手术中应用的临床效果及安全性.方法 回顾27例(31只眼)晶状体不全脱位合并白内障的患者,年龄30～78岁,Ⅲ～Ⅳ级核.其中外伤性白内障14只眼,马方综合征12只眼,过熟期白内障2只眼,并发性白内障1只眼,超声乳化白内障吸除术中悬韧带离断1只眼,原因不详者1只眼.根据脱位程度及核的硬度配合使用1～4个虹膜拉钩.术中视玻璃体脱出情况行前段玻璃体切除术.术后评估视力、术后反应.对各项观察指标进行相关分析.结果 术中无出现囊膜撕裂、核下坠、眼内明显出血等严重并发症.术中玻璃体脱出占29.0%(9/31),与晶状体脱位范围有显著相关性(r=0.453,P=0.010);但无1例出现于晶状体核超声乳化过程中,其中仅6例需行前部玻璃体切除.术后0.5～1.0个月复查,患者最佳矫正视力0.2～1.2,较术前提高1～12行,平均(6.0±2.7)行,其中23只眼≥0.5.术后角膜水肿与是否行玻璃体切除有显著相关性(r=0.398,P=0.026),与脱位程度、虹膜拉钩使用个数、超声乳化能量及时间、人工晶状体类型无明显相关性(P＞0.05).结论 虹膜拉钩辅助进行超声乳化白内障吸除可简化晶状体不全脱位合并白内障的手术治疗过程,个体化的手术方案及术中灵活果断的措施,在晶状体病范畴的这一复杂而危险的病例治疗中取得良好的有效性及安全性.
目的 探討虹膜拉鉤輔助在伴不全脫位白內障手術中應用的臨床效果及安全性.方法 迴顧27例(31隻眼)晶狀體不全脫位閤併白內障的患者,年齡30～78歲,Ⅲ～Ⅳ級覈.其中外傷性白內障14隻眼,馬方綜閤徵12隻眼,過熟期白內障2隻眼,併髮性白內障1隻眼,超聲乳化白內障吸除術中懸韌帶離斷1隻眼,原因不詳者1隻眼.根據脫位程度及覈的硬度配閤使用1～4箇虹膜拉鉤.術中視玻璃體脫齣情況行前段玻璃體切除術.術後評估視力、術後反應.對各項觀察指標進行相關分析.結果 術中無齣現囊膜撕裂、覈下墜、眼內明顯齣血等嚴重併髮癥.術中玻璃體脫齣佔29.0%(9/31),與晶狀體脫位範圍有顯著相關性(r=0.453,P=0.010);但無1例齣現于晶狀體覈超聲乳化過程中,其中僅6例需行前部玻璃體切除.術後0.5～1.0箇月複查,患者最佳矯正視力0.2～1.2,較術前提高1～12行,平均(6.0±2.7)行,其中23隻眼≥0.5.術後角膜水腫與是否行玻璃體切除有顯著相關性(r=0.398,P=0.026),與脫位程度、虹膜拉鉤使用箇數、超聲乳化能量及時間、人工晶狀體類型無明顯相關性(P＞0.05).結論 虹膜拉鉤輔助進行超聲乳化白內障吸除可簡化晶狀體不全脫位閤併白內障的手術治療過程,箇體化的手術方案及術中靈活果斷的措施,在晶狀體病範疇的這一複雜而危險的病例治療中取得良好的有效性及安全性.
목적 탐토홍막랍구보조재반불전탈위백내장수술중응용적림상효과급안전성.방법 회고27례(31지안)정상체불전탈위합병백내장적환자,년령30～78세,Ⅲ～Ⅳ급핵.기중외상성백내장14지안,마방종합정12지안,과숙기백내장2지안,병발성백내장1지안,초성유화백내장흡제술중현인대리단1지안,원인불상자1지안.근거탈위정도급핵적경도배합사용1～4개홍막랍구.술중시파리체탈출정황행전단파리체절제술.술후평고시력、술후반응.대각항관찰지표진행상관분석.결과 술중무출현낭막시렬、핵하추、안내명현출혈등엄중병발증.술중파리체탈출점29.0%(9/31),여정상체탈위범위유현저상관성(r=0.453,P=0.010);단무1례출현우정상체핵초성유화과정중,기중부6례수행전부파리체절제.술후0.5～1.0개월복사,환자최가교정시력0.2～1.2,교술전제고1～12행,평균(6.0±2.7)행,기중23지안≥0.5.술후각막수종여시부행파리체절제유현저상관성(r=0.398,P=0.026),여탈위정도、홍막랍구사용개수、초성유화능량급시간、인공정상체류형무명현상관성(P＞0.05).결론 홍막랍구보조진행초성유화백내장흡제가간화정상체불전탈위합병백내장적수술치료과정,개체화적수술방안급술중령활과단적조시,재정상체병범주적저일복잡이위험적병례치료중취득량호적유효성급안전성.
Objective To study the clinical effects and safety of the auxiliary management with iris retractor for subluxated lens combined with cataract. Methods Thirty-one eyes lens subluxation with cataract come from 27 patients were reviewed, all of them were 30-78 years old and Ⅲ-Ⅳ grade of nuclear. Among these patients, 14 were traumatic cataracts, 12 Marfan syndromes, two over-mature phase of cataracts, one caused suspensory ligament broken during phacoemulsification, and one unclear reason. 1 to 4 iris retractors were used during surgeries, according to the extension of zonular loss and nuclear hardness.Anterior vitrectomy would be taken if vitreous prolapsed. Visual acuities and reactions post-operative were observed, too. And correlation analysis would be used to study the relationship of those objections. Results There were no serious complications during the surgeries such as tearing of capsular, falling of nuclear,bleeding of intraocular, and so on. Only 9 of 31 eyes (29.0%) had vitreous prolapsed interoperations,which appeared a significant correlated with range of zonular loss ( Spearman r = 0. 453, P = 0. 010 ).However, none of them happened during the phacoemulsification for lens nucleus and only 6 eyes took the anterior vitrectomy. The best corrected postoperative visual acuity of these patients attended to 0. 2-1.2 at a half to 1 month, increased by 1-12 lines[average of (6.0 ±2.7) lines] compared with preoperative.Twenty-three eyes visual acuity of them were no less than 0. 5. Corneal edema postoperatively appeared a significant correlated with vitrectomy ( Spearman r = 0. 398, P = 0. 026), while seemed no associated with the range of zonular loss, the number of iris retractors, energy and duration of ultrasound burst or type of intraocular lens (IOL) (P ＞ 0. 05 ). Conclusions Phacoemulsification assists with iris retractor can simplify the process of cataract surgery of subluxated lens. Individualized surgical planning and flexible and decisive measures intra-operative achieved good results and well safety in these dangerous and complex lens diseases.
