[1]景清荷,陈佳惠,季樱红,等.前段玻璃体切割联合Cionni张力环在伴有前房玻璃体脱出的外伤性晶状体半脱位手术中的应用[J].眼科新进展,2017,37(6):535-538.[doi:10.13389/j.cnki.rao.2017.0135]
 JING Qing-He,CHEN Jia-Hui,JI Ying-Hong,et al.Application of anterior vitrectomy combined with Cionni tension ring in traumatic lens subluxation surgery with anterior vitreous prolapse[J].Recent Advances in Ophthalmology,2017,37(6):535-538.[doi:10.13389/j.cnki.rao.2017.0135]
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前段玻璃体切割联合Cionni张力环在伴有前房玻璃体脱出的外伤性晶状体半脱位手术中的应用/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
37卷
期数:
2017年6期
页码:
535-538
栏目:
应用研究
出版日期:
2017-06-05

文章信息/Info

Title:
Application of anterior vitrectomy combined with Cionni tension ring in traumatic lens subluxation surgery with anterior vitreous prolapse
作者:
景清荷陈佳惠季樱红杨晋蒋永祥卢奕
200031 上海市,复旦大学附属眼耳鼻喉科医院眼科
Author(s):
JING Qing-HeCHEN Jia-HuiJI Ying-HongYANG JinJIANG Yong-XiangLU Yi
Department of Ophthalmology,Eye and ENT Hospital of Fudan University,Shanghai 200031,China
关键词:
晶状体半脱位白内障晶状体囊Cionni改良张力环超声乳化白内障吸出术前段玻璃体切割术
Keywords:
lens subluxationcataractlens capsuleCionni-modified capsular tension ringphacoemulsificationanterior vitrectomy
分类号:
R779.66
DOI:
10.13389/j.cnki.rao.2017.0135
文献标志码:
A
摘要:
目的 探讨应用前段玻璃体切割、囊袋拉钩联合Cionni改良张力环(Cionni-modified capsular tension ring,MCTR)在伴有前房玻璃体脱出的外伤性晶状体半脱位手术中的有效性和安全性。方法 伴有前房玻璃体脱出的外伤性晶状体半脱位患者16例(16眼),脱位范围在90°~120° 7眼、>120°~180° 5眼、>180°~270° 4眼,其中合并虹膜根部离断3眼、express植入1眼、青光眼瓣膜阀植入1眼。根据前房玻璃体情况,行曲安奈德染色后经前房或睫状体平坦部行玻璃体切割术,连续环形撕囊后使用2~4个囊袋拉钩钩住撕囊边缘,稳定晶状体囊袋并使其居中,超声乳化白内障吸出、MCTR植入及巩膜层间缝合固定,晶状体囊袋内植入折叠人工晶状体(intraocular lens,IOL)。术后随访3个月,观察术后视力、术中术后并发症、前囊口、IOL位置、眼压情况。结果 所有患者均顺利完成白内障吸出、MCTR及IOL植入;其中植入双钩MCTR 7眼,单钩9眼。术后视力>0.5者9眼,>0.3~0.5者4眼,>0.1~0.3者2眼,≤0.1者1眼,术后术眼最佳矫正视力与术前比较,差异有统计学意义(χ2=17.503,P=0.000)。Pantacam眼前段分析系统获得Scheimpflug图像分析IOL居中性好,无MCTR及IOL移位等并发症发生。术中术后并发症有皮质残留、房水后部返流综合征、前囊撕裂、前囊口收缩、后囊膜混浊等。结论 有效前房或睫状体平坦部玻璃体切割是减少手术并发症的关键,前段玻璃体切割、囊袋拉钩联合Cionni张力环植入是伴有前房玻璃体脱出的外伤性晶状体不全脱位较理想的术式选择。
Abstract:
Objective To investigate the effectiveness and safety of anterior vitrectomy combined with capsular retractor and Cionni modified capsular tension ring (MCTR) in traumatic lens subluxation surgery with anterior vitreous prolapse.Methods This study comprised 16 patients (16 eyes) of traumatic lens subluxation with anterior vitreous prolapse,in which iridodialysis was in 3 eyes,express implantation in 1 eye and Ahmed glaucoma valve implantation in 1 eye.According to the severity of lens subluxation,the patients were divided into three levels,including 90°-120° (7 eyes),120°-180° (5 eyes) and 180°-270° (4 eyes).Considering the anterior vitreous prolapse,anterior vitrectomy or/and pars plan vitrectomy was conducted with assistance of triamcinolone acetonide.After continuous curvilinear capsulorhexis,two to four capsular retractors were placed in the capsulorhexis to support and center the capsule.MCTR was inserted with scleral suture fixation after phacoemulsification.At last,the foldable IOL was implanted to capsular bag.Postoperative visual acuity,intra- and post-operative complications,anterior capsular opening,IOL positions and intraocular pressure (IOP) were assessed during 3 months’ follow up.Results All patients had successfully undergone phacoemulsification,MCTR insertion and IOL implantation.Seven eyes were inserted with 2-eyelet MCTR and nine eyes were inserted with 1-eyelet MCTR.The postoperative visual acuity was better than 0.5 in 9 eyes,between 0.3 and 0.5 in 4 eyes,between 0.1 and 0.3 in 2 eyes,and less than 0.1 in 1 eye.Compared with pre-operation,the difference in the visual acuity was statistically significant (χ2=17.503,P=0.000).The scheimpflug images obtained from the Pentacam,which demonstrated that the IOL was well centered,and no MCTR and IOL decentration occurred.The common intra- and post-operative complications were residual cortex,aqueous misdirection syndrome,anterior capsular tears,anterior capsular phimosis and posterior capsular opacification.Conclusion The effective application of anterior vitrectomy is the key point to reduce surgical complications.Anterior vitrectomy combined with insertion of capsular retractor and MCTR is an ideal surgical option for patients of traumatic lens subluxation with anterior vitreous prolapse.

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备注/Memo

备注/Memo:
国家自然科学联合基金资助(编号:U1503124);新疆少数民族科技人才特殊培养计划基金资助(编号:201423116)
更新日期/Last Update: 2017-06-28