CAJ | 학술논문

目的探讨内窥镜引导人工晶状体(IOL)睫状钩缝线固定术对玻璃体切除术(PPV)后无晶状体眼的血-房水屏障功能的影响.方法 38例(39只眼)入组.33只眼为接受PPV联合经平坦部晶状体切除(PPL)术后无晶状体眼,其中21只眼既往经受较严重的眼球挫伤或异物伤,3只眼为内源性眼内炎,9只眼为增生性糖尿病视网膜病变.其他6只眼为对照组,包括年龄相关性白内障晶状体超声乳化吸出及人工晶状体植入术3只眼,无内窥镜引导的常规人工晶状体囊袋内植入术3只眼.观察指标包括:术后视力、裂隙灯显微镜检查、UBM检查及激光前房闪光细胞检测仪检测IOL固定术前1d及术后1,7,30 d房水闪光光度值等.结果术后最佳矫正视力0.2 ～1.0平均(0.6±0.21),优于术前的手动/30 cm ～ 0.2.无术中、术后出血等并发症.UBM显示术后1周常规IOL固定的1眼IOL轻度倾斜偏位.与超声乳化白内障摘除及IOL植入术相比,常规IOL固定术和内窥镜引导IOL固定术术后房水闪光值均显著增加,尤其是在术后1d,房水闪光值达到最高峰(F =216.2,214.1,P＜0.05);并且,常规IOL固定术后房水闪光值高于内窥镜辅助IOL固定组(F =220.3,P＜0.05);术后1周房水闪光值逐渐下降,至术后1个月时两组差异无统计学意义(F=205.0,P＞0.05);与手术前1d房水闪光值相比,3种手术方式均有统计学意义(F =233.1,212.3,204.9,P＜0.05).结论内窥镜引导的IOL固定对血-房水屏障(BAB)破坏相对轻微,并且恢复迅速.睫状沟与睫状体平坦部及虹膜根部的不同解剖学特点也是IOL固定位置不同引起BAB表现各异的重要原因之一.
목적 탐토내규경인도인공정상체(IOL)첩상구봉선고정술대파리체절제술(PPV)후무정상체안적혈-방수병장공능적영향.방법 38례(39지안)입조.33지안위접수PPV연합경평탄부정상체절제(PPL)술후무정상체안,기중21지안기왕경수교엄중적안구좌상혹이물상,3지안위내원성안내염,9지안위증생성당뇨병시망막병변.기타6지안위대조조,포괄년령상관성백내장정상체초성유화흡출급인공정상체식입술3지안,무내규경인도적상규인공정상체낭대내식입술3지안.관찰지표포괄:술후시력、렬극등현미경검사、UBM검사급격광전방섬광세포검측의검측IOL고정술전1d급술후1,7,30 d방수섬광광도치등.결과 술후최가교정시력0.2 ～1.0평균(0.6±0.21),우우술전적수동/30 cm ～ 0.2.무술중、술후출혈등병발증.UBM현시술후1주상규IOL고정적1안IOL경도경사편위.여초성유화백내장적제급IOL식입술상비,상규IOL고정술화내규경인도IOL고정술술후방수섬광치균현저증가,우기시재술후1d,방수섬광치체도최고봉(F =216.2,214.1,P＜0.05);병차,상규IOL고정술후방수섬광치고우내규경보조IOL고정조(F =220.3,P＜0.05);술후1주방수섬광치축점하강,지술후1개월시량조차이무통계학의의(F=205.0,P＞0.05);여수술전1d방수섬광치상비,3충수술방식균유통계학의의(F =233.1,212.3,204.9,P＜0.05).결론 내규경인도적IOL고정대혈-방수병장(BAB)파배상대경미,병차회복신속.첩상구여첩상체평탄부급홍막근부적불동해부학특점야시IOL고정위치불동인기BAB표현각이적중요원인지일.
Objective To observe the function of the blood-aqueous barrier(BAB) after transscleral sulcus suture intraocular lens (IOL) fixation under endoscope guidance.Methods 39 eyes of 38 cases were enrolled in this study.Endoscope-assissted transscleral IOL fixation was performed in 33 eyes,of which 21 eyes were eyeball contusion or foreign body injury,3 eyes were endogenous endophthalmitis,and 9 eyes were proliferative diabetic retinopathy.A foldable IOL was fixed in ciliary sulcus.3 eyes underwent phacoemulsification combined with IOL implantation and 3 eyes with regular IOL fixation without endoscope guidance were taken as control.The observed items included post-surgery vision and slit-lamp microscopy.The BAB function was examined using the laser flare cell meter (Kowa FC-2000) preoperatively and on postoperative day 1,7,30 by an independent examiner.The wilcoxon test was used for data analysis.Results Postoperatively,the best corrected visual acuities of all cases ranged from 0.2 ～ 1.0 (0.6 ± 0.21),were better than pre-operative hand movement/30 cm ～0.2.The UBM indicated the IOL of 1 eye dislocated slightly in regular IOL fixation group 1 week after surgery.The aqueous flare mean photon counts showed significant difference (F =216.2,214.1,P ＜ 0.05) in endoscope-assissted and regular lens fixation groups between phacoemulsification before surgery and after surgery especially on postoperative day 1,and highly significant difference between the regular lens fixation and the endoscope assissted on day 1 (F =220.3,P ＜ 0.05),but no statistically significant difference (F =205.0,P ＞ 0.05) on postoperative day 30.Conclusion Endoscope-assissted transscleral IOL fixation has little effect on BAB function.The different anatomical characteristics of ciliary sulcus,pars plana and iris root may be crucial reasons for different BAB damage.