Artisan虹膜夹持型人工晶状体植入治疗马凡综合征晶状体半脱位

目的探讨Artisan 虹膜夹持型人工晶状体（IOL）植入术治疗马凡综合征晶状体半脱位的有效性和安全性。方法 回顾性病例研究。2007年12月至2011年7月在广东省人民医院眼科确诊的马凡综合征晶状体半脱位患者16例（25眼），行连续环形撕囊后，完成晶状体吸除、晶状体囊膜切除、前段玻璃体切割、Artisan IOL前房虹膜夹持固定和虹膜周边切除术。比较手术前后裸眼视力（UCVA）、最佳矫正视力（BCVA）、眼压、角膜内皮细胞计数，记录术后虹膜夹持型IOL位置、角膜内皮细胞丢失率，术中、术后并发症情况。随访时间6个月。采用非参数检验（Wilcoxon 检验）对手术前后UCVA和BCVA进行比较。结果 术后6个月UCVA和BCVA均较术前明显提高，术前和术后6个月UCVA（logMAR）分别为1.05±0.26和0.46±0.29，两者相比差异有统计学意义（Z=-4.530，P<0.01）。术前和术后6个月BCVA（logMAR）分别为0.68±0.32和0.27±0.22，两者相比差异具有统计学意义（Z=-2.208，P<0.01）。术后所有患眼虹膜夹持型IOL位置居中，单眼复视症状消失。术后2眼出现一过性高眼压，1眼出现脉络膜脱离，1眼出现视网膜脱离，未发生IOL移位、角膜失代偿等严重并发症。术后6个月平均角膜内皮细胞丢失率为5.6%。结论 Artisan虹膜夹持型IOL植入治疗晶状体严重脱位可提高视力，消除单眼复视且安全有效。

Artisan aphakic intraocular lens implantation for subluxated lenses in patients with Marfan syndrome

ObjectiveTo evaluate the efficacy and safety of Artisan aphakic intraocular lens （IOL） implantation for subluxated lenses in patients with Marfan syndrome （MFS）. Methods In this retrospective study， 25 eyes of 16 patients with subluxated lenses due to MFS accepted continuous circular capsulorhexis （CCC）， lens aspiration， lens capsule removal， anterior vitrectomy， Artisan IOL implantation， and peripheral iridectomy between December 2007 and July 2011 in Guangdong General Hospital. The patients were followed for uncorrected visual acuity （UCVA）， best corrected visual acuity （BCVA） and endothelial cell counts， Artisan IOL position， and occurrence of complications. The average follow-up period was 6.0 months. Non-parameteric test （Wilcoxon signed ranks） was used to compare UCVA and BCVA before and after operation. Results Six months after Artisan IOL implantation， UCVA improved from 1.05±0.26 to 0.46±0.29 （Z=-4.530， P<0.01）； BCVA improved from 0.68±0.32 to 0.27±0.22 （Z=-2.208， P<0.01）. The symptoms of monocular diplopia disappeared and mean endothelial cell loss was 5.6% 6 months postoperatively. Postoperative complications included temporary high intraocular pressure （2 eyes）， choroidal detachment （1 eye） and retinal detachment （1 eye）. No significant postoperative complications were observed， such as displacement of IOL and corneal decompensation. Conclusion Artisan aphakic intraocular lens implantation for subluxated lenses is a kind of safe and effective technique for recovering vision and eliminating monocular diplopia as far as possible.