后房型人工晶体脱位的临床分析

doi:10.6040/j.issn.1673-3770.0.2018.430

摘要/Abstract

摘要： 目的探讨后房型人工晶体脱位的发生原因及危险因素、临床特征,比较不同手术方式治疗效果,从而提高对该白内障术后并发症的认识。方法回顾性分析2007年9月-2017年9月间烟台毓璜顶医院眼科收治的后房型人工晶体脱位的患者,根据发生时间,分为早发型人工晶体脱位组(<3个月)和晚发型人工晶体脱位组(≥3个月)。分别对原发病及所行手术、既往手术史、眼合并症、眼轴、人工晶体脱位的原因、术后发生人工晶体脱位的时间、人工晶体脱位的类型和程度、人工晶体脱位处理的手术方式等信息进行统计学分析。结果早期人工晶体脱位组11眼,其中后囊破裂9眼(81.8%),外伤1眼(9.1%),合并高度近视者2眼(18.2%),玻璃体切割术后4眼(36.4%)。晚期人工晶体脱位组62眼,外伤12眼(19.4%),后囊破裂16眼(25.8%),悬韧带断裂27眼(43.5%),合并高度近视20眼(32.3%),葡萄膜炎7眼(11.3%),视网膜色素变性4眼(6.5%),玻璃体切割术后11眼(17.7%),假性囊膜剥脱综合征4眼(6.5%)。术前与术后裸眼视力差异有统计学意义。比较置换术与复位术术前及术后裸眼视力差异无统计学意义。结论早期人工晶体脱位多与术中后囊破裂、人工晶体放置位置不当等手术相关因素有关。晚期人工晶体脱位多与悬韧带断裂、后囊破裂等原因相关,高度近视、既往玻璃体手术史、葡萄膜炎等均为人工晶体脱位的危险因素。鉴于人工晶体脱位临床表现复杂,需根据具体情况制定相应治疗策略。

关键词: 人工晶体脱位, 术后并发症, 后囊膜破裂, 危险因素

Abstract: Objective To identify the predisposing factors and clinical characteristics of posterior intraocular lens dislocation, and to compare the surgical outcomes following treatment of dislocated intraocular lens. Methods This study is a retrospective evaluation of all cases with posterior intraocular lens dislocation that presented at the Yuhuangding Hospital from September 2007 until September 2017. All cases were divided into an early intraocular lens dislocation group(<3 months)and a late intraocular lens dislocation group(≧3 months)according to the time of occurrence. The medical records of 73 eyes of 70 patients were evaluated. The main outcome measures were primary disease and surgery, previous surgical history, ocular complications, axial, causes of dislocation, interval between cataract surgery and dislocation, type and degree of dislocation of intraocular lens, and surgical method for treatment of the dislocation. Results There were 11 eyes in the early intraocular lens dislocation group, including 9 eyes(81.8%)with posterior capsule rupture, 1 eye(9.1%)with history of trauma, 2 eyes(18.2%)with high myopia, and 4 eyes(36.4%)with prior vitrectomy. There were 62 eyes in the late intraocular lens dislocation group, including 12 eyes(19.4%)with history of trauma, 16 eyes(25.8%)with posterior capsule rupture, 27 eyes(43.5%)with zonular dehiscence, 20 eyes(32.3%)with high myopia, 7 eyes(11.3%)with uveitis, 4 eyes(6.5%)with retinitis pigmentosa, 11 eyes(17.7%)with prior vitrectomy, and 4 eyes(6.5%)with pseudoexfoliation syndrome. There were significant differences in the UCVA between the preoperative and postoperative stages. There was no significant difference in the UCVA between reposition and exchange. Conclusion Early dislocation of the intraocular lens is associated with surgical factors, such as posterior capsule rupture and improper placement of the intraocular lens. Late dislocation of the intraocular lens is associated with posterior capsule rupture and zonular dehiscence. High myopia, prior vitrectomy, and uveitis are risk factors for dislocation of the intraocular lens. It is necessary to choose the appropriate surgical method based on the complexity of dislocation of the intraocular lens.

Key words: Intraocular lens dislocation, Postoperative complications, Posterior capsule rupture, Risk factors

中图分类号:

R776

姜秀颖,李元彬. 后房型人工晶体脱位的临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 105-110.

JIANG Xiuying, LI Yuanbin. Clinical analysis of posterior intraocular lens dislocation[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 105-110.

参考文献

[1] Lorente R, de Rojas V, Vazquez de Parga P, et al. Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases[J]. J Cataract Refract Surg, 2010, 36(8): 1270-1282.doi: 10.1016/j.jcrs.2010.01.035.
[2] Chai F, Ma B, Yang XG, et al. A pilot study of intraocular lens explantation in 69 eyes in Chinese patients[J]. Int J Ophthalmol, 2017, 10(4): 579-585.doi: 10.18240/ijo.2017.04.13.
[3] 李厚秀, 刘中华, 陈智. 白内障超声乳化术中后囊膜破裂风险因素分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 88-90. LI Houxiu, LIU Zhonghua, CHEN Zhi. Risk factors for rupture of the capsule membrane during phacoemulsification cataract surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(2): 88-90.doi: 10.6040/j.issn.1673-3770.0.2017.267.
[4] Ascaso FJ, Huerva V, Grzybowski A. Epidemiology, etiology, and prevention of late IOL-capsular bag complex dislocation: review of the literature[J]. J Ophthalmol, 2015, 2015: 805706.doi: 10.1155/2015/805706.
[5] Dabrowska-Kloda K, Kloda T, Boudiaf S, et al. Incidence and risk factors of late in-the-bag intraocular lens dislocation: evaluation of 140 eyes between 1992 and 2012[J]. J Cataract Refract Surg, 2015, 41(7): 1376-1382.doi: 10.1016/j.jcrs.2014.10.040.
[6] Kristianslund O, Råen M, Østern AE, et al. Late in-the-bag intraocular lens dislocation[J]. Ophthalmology, 2017, 124(2): 151-159.doi: 10.1016/j.ophtha.2016.10.024.
[7] Fontana L, Coassin M, Iovieno A, et al. Cataract surgery in patients with pseudoex-foliation syndrome: current updates[J]. Clin Ophthalmol, 2017, 11: 1377-1383.doi: 10.2147/OPTH.S142870.
[8] Fernández-Buenaga R, Alio JL, Pérez-Ardoy AL, et al. Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes[J]. Eye(Lond), 2013, 27(7): 795-801.doi: 10.1038/eye.2013.95.
[9] Fujikawa A, Mohamed YH, Kinoshita H, et al. Spontaneous dislocation of the posterior chamber intraocular lens[J]. Int Ophthalmol, 2018, 38(3): 1111-1117.doi: 10.1007/s10792-017-0567-6.
[10] Hocaoglu M, Karacorlu M, Sayman Muslubas I, et al. Incidence and factors associated with complications of sutured and sutureless cataract surgery following pars plana vitrectomy at a tertiary referral centre in Turkey[J]. Br J Ophthalmol, 2016, 100(9): 1206-1210.doi:10.1136/bjophthalmol-2015-307001.
[11] Pueringer SL, Hodge DO, Erie JC. Risk of late intraocular lens dislocation after cataract surgery, 1980-2009: a population-based study[J]. Am J Ophthalmol, 2011, 152(4): 618-623.doi: 10.1016/j.ajo.2011.03.009.
[12] Kr(·overe)pšt(·overe)L, Kuzmien(·overe)L, Miliauskas A, et al. Possible predisposing factors for late intraocular lens dislocation after routine cataract surgery[J]. Medicina(Kaunas), 2013, 49(5): 229-234.
[13] Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050[J]. Ophthalmology, 2016, 123(5): 1036-1042.doi: 10.1016/j.ophtha.2016.01.006.
[14] Verkicharla PK, Ohno-Matsui K, Saw SM. Current and predicted demographics of high myopia and an update of its associated pathological changes[J]. Ophthalmic Physiol Opt, 2015, 35(5): 465-475.doi:10.1111/opo.12238.
[15] Davis D, Brubaker J, Espandar L, et al. Late in-the-bag spontaneous intraocular lens dislocation[J]. Ophthalmology, 2009, 116(4): 664-670.doi:10.1016/j.ophtha.2008.11.018.
[16] Matsumoto M, Yamada K, Uematsu M, et al. Spontaneous dislocation of in-the-bag intraocular lens primarily in cases with prior vitrectomy[J]. Eur J Ophthalmol, 2012, 22(3): 363-367.doi: 10.5301/ejo.5000046.
[17] Tsinopoulos IT, Tsaousis KT, Kymionis GD, et al. Comparison of anterior capsule contraction between hydrophobic and hydrophilic intraocular lens models[J]. Graefes Arch Clin Exp Ophthalmol, 2010, 248(8): 1155-1158.doi:10.1007/s00417-010-1373-2.
[18] Abela-Formanek C, Amon M, Kahraman G, et al. Biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in eyes with uveitis having cataract surgery: Long-term follow-up[J]. J Cataract Refract Surg, 2011, 37(1): 104-112.doi: 10.1016/j.jcrs.2010.07.038.
[19] Rönbeck M, Zetterström C, Wejde G, et al. Comparison of posterior capsule opacification development with 3 intraocular lens types: five-year prospective study[J]. J Cataract Refract Surg, 2009, 35(11): 1935-1940.doi: 10.1016/j.jcrs.2009.05.048.
[20] Choi M, Lazo MZ, Kang MJ, et al. Effect of number and position of intraocular lens haptics on anterior capsule contraction: a randomized, prospective trial[J]. BMC Ophthalmol, 2018, 18(1): 78.doi:10.1186/s12886-018-0742-1.
[21] 郝燕生. 后房型人工晶状体脱位于前玻璃体腔的原因及其处理方法[J]. 中华眼科杂志, 2003, 39(4): 228-230.doi: 10.3760/j: issn: 0412-4081.2003.04.009. HAO Yansheng. The cause and management of intraocular lens dislocation into anterior vitreous cavity[J]. Chinese Journal of Ophthalmology, 2003, 39(4): 228-230.doi:10.3760/j:issn:0412-4081.2003.04.009.
[22] Gul A, Duran M, Can E, et al. Surgical management of intraocular lens dislocations[J]. Arq Bras Oftalmol, 2015, 78(5): 313-317.doi:10.5935/0004-2749.20150082.
[23] Nadal J, Kudsieh B, Casaroli-Marano RP. Scleral fixation of posteriorly dislocated intraocular lenses by 23-gauge vitrectomy without anterior segment approach[J]. J Ophthalmol, 2015, 2015: 391619.doi:10.1155/2015/391619.
[24] 吕林, 谭显里. 人工晶体脱入玻璃体腔的手术处理[J]. 中华眼科杂志, 1999(2): 101.doi:10.3760/j:issn:0412-4081.1999.02.006.
[25] Obeng FK, Vig VK, Singh P, et al. Posterior chamber scleral fixation of intraocular lenses in post-vitrectomised aphakic eyes[J]. J Clin Diagn Res, 2017, 11(3): NC09-NC13.doi:10.7860/JCDR/2017/20989.9533.
[26] 李元彬, 高磊, 姜鹏飞. 巩膜板层迂回缝线人工晶体固定法临床观察[J]. 中华全科医师杂志, 2011, 10(7): 516-517.doi:10.3760/cma.j.issn.1671-7368.2011.07.026.
[27] Baba T, Nizawa T, Oshitari T, et al. Comparisons of visual and surgical outcomes after reuse or replacement of dislocated in-the-bag intraocular lens[J]. J Ophthalmol, 2018, 2018: 7342917.doi: 10.1155/2018/7342917.
[28] Gimbel HV, Condon GP, Kohnen T, et al. Late in-the-bag intraocular lens dislocation: incidence, prevention, and management[J]. J Cataract Refract Surg, 2005, 31(11): 2193-2204. doi: 10.1016/j.jcrs.2005.06.053.

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