先天性晶状体脱位31例的手术治疗观察

发布时间：2018-04-27 05:27

本文选题：先天性晶状体脱位 + 囊袋张力环　；参考：《国际眼科杂志》2016年10期

【摘要】：目的:通过对先天性晶状体脱位行手术治疗的患者进行临床分析及手术方式选择、手术后效果分析,探讨先天性晶状体脱位患者的手术方式的选择及术中术后并发症的防治。方法:回顾性分析我院自2010-01-01/2015-01-01的5a间先天性晶状体脱位行手术治疗的患者共31例57眼,进行临床分析及手术方式选择、手术后效果、并发症分析。结果:先天性晶状体脱位临床最常见的类型为单纯性晶状体半脱位和Marfan综合征晶状体半脱位。57眼中1眼为Marchesani综合征继发性青光眼导致视神经萎缩,术后视力无改善,其余56眼(98%)术后视力均较术前有不同程度提高。手术方式:晶状体超声乳化摘除+人工晶状体植入术3眼(5%);晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术8眼(14%),其中1眼行囊袋张力环巩膜缝合固定;经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术39眼(68%),其中2眼联合小梁切除术,未植入人工晶状体;晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术5眼(9%);经睫状体平坦部切口晶状体切除联合玻璃体切除术+硅油注入术2眼(4%)。结论:先天性晶状体脱位经过手术治疗大多数患者均可取得较为满意的术后效果。对于晶状体半脱位范围90°者,可单纯行晶状体超声乳化摘除+人工晶状体植入术;晶状体半脱位范围90°~180°者,行晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术;晶状体半脱位范围180°者,经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术,术后效果优于晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术;根据患者晶状体脱位程度,尽量选择切口较小的微创的手术方式是手术取得成功的关键。
[Abstract]:Objective: to explore the choice of surgical methods and the prevention and treatment of postoperative complications in patients with congenital lens dislocation through clinical analysis and choice of surgical methods and analysis of postoperative effects. Methods: a total of 31 patients (57 eyes) with congenital lens dislocation treated in our hospital during the 5-year period from 2010-01-01 / 2015-01-01 were analyzed retrospectively. Results: the most common clinical types of congenital lens dislocation were simple lens subluxation and Marfan syndrome lens subluxation. One eye in the eyes of Marchesani syndrome secondary glaucoma caused optic nerve atrophy, but the visual acuity did not improve after operation. The postoperative visual acuity of 56 eyes (98 eyes) was improved in different degree than that before operation. Methods: phacoemulsification and intraocular lens implantation were performed in 3 eyes (5 eyes), phacoemulsification bag tension ring implantation (8 eyes) and intraocular lens implantation (14 eyes), among which, 1 eye underwent bag tension loop scleral suture fixation. Transcorneal incision lens resection combined with anterior vitrectomy intraocular lens suture fixation in 39 eyes (68 eyes), including 2 eyes combined with trabeculectomy, no intraocular lens implantation; Intracapsular excision combined with anterior vitrectomy intraocular lens suture fixation in 5 eyes and transciliary flat incision in 2 eyes and vitrectomy silicone oil injection in 2 eyes. Conclusion: most patients with congenital lens dislocation can obtain satisfactory postoperative results. Phacoemulsification and intraocular lens implantation can be performed for 90 掳subluxation of lens, phacoemulsification for 90 掳or 180 掳for lens subluxation, and intraocular lens implantation with bag tension ring implantation for lens subluxation, and phacoemulsification for 90 掳or 180 掳phacoemulsification, and phacoemulsification for intraocular lens implantation. In the patients with 180 掳subluxation, intraocular lens suture fixation through corneal incision combined with anterior vitrectomy was superior to intraocular lens suture fixation after intracapsular excision and anterior vitrectomy. According to the degree of lens dislocation, the key to successful operation is to select minimally invasive surgical method with small incision as far as possible.
【作者单位】：中国陕西省西安市第四医院眼科;
【分类号】：R779.6

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