CAJ | 학술논문

目的探讨23G微创玻璃体切割手术在晶状体后脱位中的应用价值.方法对2011年1月至2013年12月间在云南省第二人民医院眼科就诊的晶状体后脱位病例43例(43只眼),根据术前检查晶状体核的情况(Emery分级系统)和患者年龄不同,分为A组:23G PPV联合超声粉碎者15例;B组:23G PPV手术26例;C组:23G PPV联合经角膜缘晶状体娩出2例.术后3个月行Ⅱ期巩膜缝线固定人工晶状体植入术.结果术后随访12～18月,平均随访(14.5±1.1)月.A、B、C三组末次随访的BCVA分别与术前视力相比,差异有统计学意义(t=5.981、6.102、5.662,P＜0.001).2例(2只眼)角膜水肿消退后检查房角发现房角后退,行滤过手术后眼压降至正常.手术方案为B组的病例中,有1例术中清除玻璃体积血后发现晶状体核Ⅲ级,改为A组方案.术后并发症2例角膜水肿,1例脉络膜脱离,药物治疗后消失.结论利用23G微创玻璃体切割系统应用不同手术方案来治疗晶状体后脱位是安全有效的.
목적 탐토23G미창파리체절할수술재정상체후탈위중적응용개치.방법 대2011년1월지2013년12월간재운남성제이인민의원안과취진적정상체후탈위병례43례(43지안),근거술전검사정상체핵적정황(Emery분급계통)화환자년령불동,분위A조:23G PPV연합초성분쇄자15례;B조:23G PPV수술26례;C조:23G PPV연합경각막연정상체면출2례.술후3개월행Ⅱ기공막봉선고정인공정상체식입술.결과 술후수방12～18월,평균수방(14.5±1.1)월.A、B、C삼조말차수방적BCVA분별여술전시력상비,차이유통계학의의(t=5.981、6.102、5.662,P＜0.001).2례(2지안)각막수종소퇴후검사방각발현방각후퇴,행려과수술후안압강지정상.수술방안위B조적병례중,유1례술중청제파리체적혈후발현정상체핵Ⅲ급,개위A조방안.술후병발증2례각막수종,1례맥락막탈리,약물치료후소실.결론 이용23G미창파리체절할계통응용불동수술방안래치료정상체후탈위시안전유효적.
Objective To discuss the value of 23-gauge micro-invasive vitrectomy in treating posteriorly dislocated crystal lens.Methods Forty-three cases (43 eyes) of posteriorly dislocated crystal lens were treated in our hospital from January 2011 to December 2013.According to preoperative evaluation of lens nucleus (Emery classification system) and patients' age, the patients were divided into three groups: Group A: 15 cases using 23-gauge PPV combined with phacofragrnentation;group B: 26 cases using 23-gauge PPV;group C: 2 cases using 23-gauge PPV combined with nucleus extraction via comeal-scleral incision.The intraocular lens transscleral fixation was performed three months later.Results The follow-up duration was 12 to 18 months, (14.5±1.1) months on average.The BCVA at last visit was statistically significant better than pre-operative BCVA in group A, B and C (t =5.981, 6.102, 5.662, P value＜0.001).Two cases were detected with angle recession after corneal edema resolve.The intraocular pressure in these two cases returned to normal after the filtration surgery.One case in group B was found with grade Ⅲ nucleus after removal of vitreous hemorrhage.Thus the surgical approach was shifted to Group A.There were 2 cases of corneal edema and 1 case of choriodal detachment post-operatively, which were treated medically.Conclusions Different surgical plans using 23-gauge micro-invasive vitrectomy are effective and safe in treating posteriorly dislocated crystal lens.