麻风病患者白内障经巩膜隧道切口囊外摘除术效果观察

目的 追踪观察麻风病患者白内障经巩膜隧道切口囊外摘除手术后的临床疗效.方法 同负责治疗麻风病患者的皮肤科医生一起,筛选出适合白内障手术的麻风病患者57例(57只眼),其中麻风病并发性白内障39只眼,麻风病老年性白内障18只眼,在局麻下行经巩膜隧道切口白内障囊外摘除联合人工晶状体植入术.术后1年追踪其临床效果,并与同期的老年性白内障患者63例(63只眼)的手术效果相比较.结果 麻风病患者白内障手术术中分别出现虹膜裂伤、反应晶状体前囊膜破裂、玻璃体溢出等并发症,术后出现不同程度眼压升高、前房反应、角膜水肿、瞳孔上移等.经过一年随访,麻风病并发性白内障组术后最好的视力≥0.4者为38.5%,视力在0.1～0.3者为46.2%,<0.1者为15.4%,麻风病老年性白内障组术后最好的视力≥0.4者为72.2%,视力在0.1～0.3者为27.8%,<0.1者为0;麻风病白内障术后视力≤0.3的29例患者中,24例存在术前慢性葡萄膜炎,是术后低视力的首要原因.麻风病自内障患者出现术后慢性葡萄膜炎、术后瞳孔区膜状物形成、人工晶体移位、术后继发性青光眼等术后并发症.结论 经巩膜隧道切口白内障囊外摘除联合人工晶状体植入术治疗麻风病并发性白内障手术安全、有效,患者视力获得提高.手术前后需要加强抗炎,控制葡萄膜炎.

Retrospective evaluation of the outcome of the scleral tunnel incision in extracapsluar cataract extraction in leprosy patients

Objective To evaluate the clinical effect of the scleral tunnel incision in extracapsluar cataract extraction(ECCE)in leprosy patients. Methods Fifty-seven eyes of 57 cataract blind leprosy patients screened by dermatologists underwent the scleral tunnel incision in ECCE, including 39 eyes of complicated cataract and 18 eyes of age-related cataract retrospectively. The clinical effects were evaluated at 1 year after surgery compared with the homochronous surgery outcome of 63 eyes of 63 age-related cataract patients. Results Vitreous loss and iris trauma et cetera occurred during ECCE in leprosy patients, and also elevated intraocular pressure et cetera occurred after ECCE. The best postoperative visual acuity(VA)was better than 0.4 in 38.5% patients in the complicated cataract and in 72.2% in the age-related cataract of leprosy patients. The better VA was from 0.1 to 0.3 in 46.2% and 27.8% in the two groups, respectively, and less than 0.1 in 15.4% and 0% in the two groups, respectively. Among the 29 cases whose best VA were poorer than 0.3 in the leprosy patients, 24 cases had preoperative chronic uveitis, which seemed to be the primary reason for the poor postoperative VA in leprosy patients. Chronic uveitis and secondary glaucoma etc were the postoperative complications of ECCE in leprosy patients. Conclusions Scleral tunnel incision in extracapsluar cataract extraction is safe and effective when performed in leprosy with complicated cataract. Chronic uveitis need to be controlled pre- and postoperation.