25G玻璃体切割联合IOL巩膜层间固定术的临床疗效

摘要

目的:评价25G玻璃体切割联合人工晶状体(IOL)巩膜层间固定术的临床疗效及安全性.方法:?前瞻性临床研究.2014年10月至2016年12月期间在南京医科大学附属无锡第二医院临床检查确诊各种原因引起的晶状体脱位、IOL脱位、无晶状体眼且无后囊膜患者39例(39眼)纳入研究.采用25G玻璃体切割联合IOL巩膜层间固定术治疗.对比观察患者手术前后视力、眼压、角膜内皮细胞数量、IOL位置,以及术后IOL复位率、IOL脱位再发生率及并发症等情况,2个时间点之间的比较采用配对t检验,多个时间点之间的比较采用重复测量资料方差分析.结果:术后1周、1个月、3个月和6个月LogMAR视力较术前提高,各时间点间比较差异均有统计学意义(均P<0.05).术后各时间点眼压较术前下降,各时间点间比较差异均有统计学意义(均P<0.05).术后1周,所有患眼IOL均在位,位置居中.术后1个月,36眼(92％)IOL在位,位置居中;1眼(3％)IOL一袢暴露于结膜下;2眼(5％)IOL脱位.术后3～6个月,36眼IOL位置稳定.结论:25G玻璃体切割联合IOL巩膜层间固定术对无囊膜支撑的IOL植入具有良好的有效性及安全性.%Objective: To measure the clinical efficacy and safety of 25-G vitrectomy combined with transscleral intraocular lens (IOL) implantation. Methods: In this prospective study, patients (n=39, 39 eyes) without capsule support and experiencing lens dislocation, IOL dislocation, and aphakia were enrolled and treated with 25-G vitrectomy combined with transscleral IOL implantation. Differences in visual acuity, intraocular pressure (IOP), number of corneal endothelial cells, location of IOL, postoperative anatomic success, and the recurrence rate of IOL dislocation and complications were recorded. Data paired t-tests and repeated measured ANOVA. results: The average visual acuity (LogMARs) at 1 week, 1 month, 3 months, and 6 months after surgery were significantly differences improved compared with the pre-surgical values (P<0.05). The average IOPs at 1 week, 1 month, 3 months, and 6 months after operation were significantly differences lower compared with the pre-surgical values (P<0.05). One week after surgery, all of the implanted IOLs were in the correct position. One month after surgery, the IOLs in 36 eyes (92％) were in the correct position. The haptics of one IOL (3％) were exposed to the conjunctiva. Dislocation of two IOLs (5％) required alignment surgery at 3 and 6 months after insertion, positions of 36 IOLs were stable. conclusions: The 25-G vitrectomy combined with transscleral IOL implantation in the treatment of eyes without capsule support was effective and safe.