晶状体不全脱位现代小切口手术方式的临床探讨

发布时间：2018-06-07 05:58

本文选题：晶状体不全脱位 + 小切口手术　；参考：《大连医科大学》2010年硕士论文

【摘要】： 目的：晶状体不全脱位可导致视力下降、视物变形,也可引起继发性青光眼、视网膜脱离等并发症,其手术治疗较为复杂且棘手,传统大切口手术存在视力恢复不理想,手术并发症多,恢复时间长等不足。近年来随着眼科手术设备的日趋完善和手术技巧的不断提高,以及手术新技术、新材料的引入,使现代晶状体不全脱位手术向着微创小切口手术方向发展,术后视功能明显改善,大大地减少手术并发症,并且有效地缩短恢复时间,从而扩大了晶状体不全脱位治疗的手术适应症。本文旨在探讨在治疗晶状体不全脱位中不同方式现代小切口手术的治疗技巧以及术后临床疗效的观察。方法：回顾性研究自2008年8月至2009年10月在大连医科大学附属二院因晶状体不全脱位而行小切口晶状体手术治疗的一组患者共20例21眼。晶状体脱位范围均在1/3-2个象限内,9眼脱位范围在1-2个象限之内,其中上方脱位5眼,鼻侧脱位2眼,下方脱位2眼；12眼脱位范围1个象限。根据晶状体不全脱位范围和位置,分别采用以下2种手术方法：1.晶状体脱位范围1个象限及脱位范围在1-2个象限之内下方脱位的14眼采用单纯超声乳化晶状体吸除联合折叠式后房型人工晶状体植入术;2.晶状体脱位范围在1-2个象限之内的余下7眼采用超声乳化晶状体吸除联合囊袋张力环及折叠式后房型人工晶状体植入术(其中1眼虹膜部分缺损且脱位范围较大联合虹膜拉钩囊袋固定)。术后观察最佳矫正视力、眼压、人工晶状体位置以及手术并发症。结果：所有21眼均顺利完成手术,人工晶状体一期植入囊袋内。术后3个月最佳矫正视力较术前明显提高,差异具有非常明显的统计学意义(t=-10.45,P0.01)；两种手术方式间最佳矫正视力的提高,其差异不具有统计学意义(t=1.74,P0.05)。术后眼压较术前明显减低,差异具有明显的统计学意义(t=2.84,P0.05)；两种手术方式间眼压的降低,其差异不具有统计学意义(t=-0.87,P0.05)。两种手术方式人工晶状体正位率的差异不具有统计学意义(Fisher确切概率法,P=0.750.05)。两种手术方式均未见严重或特殊并发症。两种手术方式间的术后反应,其差异不具有统计学意义(Fisher确切概率法,P角膜水肿=0.44,P虹膜炎性反应=0.56,P高眼压=0.25,P后囊膜混浊=0.57,P0.05)。结论：在晶状体不全脱位的现代手术治疗中,根据患者和医生的具体情况选择最适宜的微创小切口手术方式,并充分运用现代眼科新技术,有利于患者视功能的改善以及术中和术后并反症的减少。
[Abstract]:Objective: lens incomplete dislocation can lead to vision loss, visual distortion, secondary glaucoma, retinal detachment and other complications, its surgical treatment is more complex and difficult, traditional large incision surgery has poor recovery of vision. There are many complications and long recovery time. In recent years, with the improvement of the equipment and technique of ophthalmic surgery, and the introduction of new techniques and materials, modern lens dislocations have been developed towards the direction of minimally invasive small-incision surgery. The postoperative visual function was improved significantly, the complications were reduced, and the recovery time was shortened effectively, thus expanding the operative indications for the treatment of incomplete lens dislocation. The purpose of this paper is to explore the treatment techniques and clinical effect of different kinds of modern small incision surgery in the treatment of incomplete lens dislocation. Methods: from August 2008 to October 2009, a group of 20 cases (21 eyes) with small incision lens surgery was performed in the second affiliated Hospital of Dalian Medical University. The range of dislocation of lens was within 1 / 3 ~ 2 quadrants and 9 eyes were within 1-2 quadrants, including 5 eyes with upper dislocation, 2 eyes with nasal dislocation, and 12 eyes with dislocation under 2 eyes. According to the range and location of incomplete dislocation of the lens, the following two surgical procedures: 1: 1 were used. Phacoemulsification combined with foldable posterior chamber intraocular lens implantation was performed in 14 eyes with dislocation range of 1 quadrant and 1-2 quadrants. The remaining 7 eyes with dislocation range within 1-2 quadrants were treated with phacoemulsification combined with capsular tension ring and foldable posterior chamber intraocular lens implantation (1 eye with partial iris defect and large dislocation range). Combined with iris retractor bag to fix the pouch. Postoperative best corrected visual acuity, intraocular pressure, intraocular lens location and surgical complications were observed. Results: all 21 eyes were successfully operated and intraocular lens was implanted into the capsule. The best corrected visual acuity (BCVA) at 3 months after operation was significantly higher than that before operation, and the difference was statistically significant (P 0.01), and the difference between the two kinds of operation methods was not statistically significant. The IOP after operation was significantly lower than that before operation, and the difference was statistically significant (P 0.05), but there was no significant difference in IOP between the two types of operation. There was no significant difference in the positive position rate of intraocular lens between the two surgical methods. There were no severe or special complications in either operation. There was no significant difference in postoperative reaction between the two methods. Fisher's exact probability method suggested that P corneal edema was 0.44m P iridoinflammatory response was 0.56p high intraocular pressure 0.25m P posterior capsular opacification was 0.57m P0.05m. Conclusion: in the modern surgical treatment of incomplete lens dislocation, the most suitable minimally invasive small incision operation is selected according to the specific conditions of the patients and doctors, and the new modern ophthalmic technique is fully utilized. It is beneficial to the improvement of visual function and the reduction of intraoperative and postoperative complications.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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