CAJ | 학술논문

目的探讨玻璃体切除(PPV)联合内窥镜引导人工晶状体(IOL)固定术对伴有晶状体位置异常的外伤性玻璃体积血的治疗效果.方法 11例(11眼)行PPV联合内窥镜辅助IOL固定术.9例采用折叠式IOL缝线固定于睫状沟,2例伴有虹膜大部脱失者采取带虹膜隔IOL缝线固定于前平坦部.对照组选取我院常规方法处理的白内障术中后囊破裂坠核的3例.观察指标包括:术后视力、前房炎症反应、眼压及超声生物显微镜检查(UBM)等.结果随访1～9个月,裸眼视力＞0.5者7眼,0.2 ～0.4者3眼,0.1者1眼.UBM显示,对照组1例IOL一侧襻位置靠后接近睫状体平坦部导致体部偏位,而内窥镜辅助手术IOL全部位置准确；裂隙灯显微镜检查所有IOL位置正常.影响术后视力恢复主要由于不规则角膜散光、黄斑水肿和视神经挫伤.结论 PPV联合内窥镜下IOL同定术是治疗严重眼外伤伴晶状体位置异常的安全有效的方法.
목적 탐토파리체절제(PPV)연합내규경인도인공정상체(IOL)고정술대반유정상체위치이상적외상성파리체적혈적치료효과.방법 11례(11안)행PPV연합내규경보조IOL고정술.9례채용절첩식IOL봉선고정우첩상구,2례반유홍막대부탈실자채취대홍막격IOL봉선고정우전평탄부.대조조선취아원상규방법처리적백내장술중후낭파렬추핵적3례.관찰지표포괄:술후시력、전방염증반응、안압급초성생물현미경검사(UBM)등.결과 수방1～9개월,라안시력＞0.5자7안,0.2 ～0.4자3안,0.1자1안.UBM현시,대조조1례IOL일측반위치고후접근첩상체평탄부도치체부편위,이내규경보조수술IOL전부위치준학；렬극등현미경검사소유IOL위치정상.영향술후시력회복주요유우불규칙각막산광、황반수종화시신경좌상.결론 PPV연합내규경하IOL동정술시치료엄중안외상반정상체위치이상적안전유효적방법.
Objective To determine the effect of combined pars plana vitrectomy (PPV) and transsclera] intraocular lens (IOL) fixation under endoscope guidance in the management of traumatic vitreous hemorrhage with dislocation of the lens or IOL.Methods Endoscope-assisted PPV and transscleral IOL fixation were performed in 11 eyes of 11 patients.The foldable IOLs were fixed in ciliary sulcus in nine cases,and an aniridia IOL was fixed in anterior pars plana in the other two cases with iris loss.3 patients with dropped nucleus in phacoemulsification process who sustained regular treatment were taken as control.Observed items included post-surgery vision,anterior chamber inflammation,intraocular pressure,ultrasound biomicroscope(UBM) examination.Results Follow-up ranged from 1 month to 9 months (4.1 ± 2.3) months.Postoperatively,uncorrected visual acuities were 0.5 or better in 7 cases,0.2-0.4 in 3 cases,0.1in one case.UBM results indicated that all IOL position fixed under endoscope-guidance were correct,whereas one side loop of one case approached to anterior pars plana in control.The main factors influencing visual rehabilitation were irregular corneal astigmatism,macular edema and optic nerve contusion.Conclusion Combined PPV and endoscopy-induced transscleral IOL fixation is effective and safe in dealing with severe eye trauma.