前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性

目的 探讨前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性。方法 选择河北省眼科医院白内障科2013年1月至2020年12月行晶状体摘出一期或二期植入前房型虹膜夹人工晶状体的患者53例62眼作为研究对象，62眼患者均为无足够囊膜支撑的无晶状体眼。术后随访3～9(5.68±1.29)年，收集患者手术前和末次随访裸眼视力(UCVA)、等效球镜度、眼压、前房深度、人工晶状体眼内固定位置及稳定性、角膜内皮细胞密度(ECD)、术后并发症等指标和临床信息。评价前房型虹膜夹人工晶状体植入术治疗无足够囊膜支撑的无晶状体眼的疗效和安全性。结果 术前62眼UCVA(logMAR)为1.55±0.56,术后为0.23±0.15,术后UCVA较术前显著提高(t=18.64,P=0.00)。术后和末次随访UCVA (logMAR)(0.22±0.14)比较，差异无统计学意义(t=1.43,P=0.16),患者术后视力保持稳定。术后末次随访1眼等效球镜度为-1.25 D(为根据另一眼预留),等效球镜度-1.00～<-0.50 D者10眼，-0.50～+0.50 D者51眼。62眼术前...

Efficacy and safety of the anterior chamber iris-claw intraocular lens implantation for the treatment of aphakic eyes without adequate capsular support

Objective　To explore the anterior chamber iris-claw intraocular lens implantation in the treatment of aphakic eyes without sufficient capsule support.
Methods　Totally 53 patients (62 eyes) who underwent an anterior chamber iris-claw intraocular lens implantation in the first or second stage of lens extraction from January 2013 to December 2020 in the Cataract Department of Hebei Eye Hospital were included. All 62 eyes were aphakic eyes without adequate capsular support. The postoperative follow-up period was 3-9 (5.68±1.29) years. Indicators and clinical information, including preoperative and last follow-up uncorrected visual acuity (UCVA), spherical equivalent (SE), intraocular pressure (IOP), anterior chamber depth, intraocular fixation position and stability of intraocular lenses, corneal endothelial cell density (ECD), postoperative complications, were collected. The efficacy and safety of anterior chamber iris-claw intraocular lens implantation in the treatment of aphakic eyes without adequate capsular were evaluated.
Results　The preoperative and postoperative UCVA (logMAR) was respectively 1.55±0.56 and 0.23±0.15, and the latter was significantly higher than the former (t=18.64, P=0.00). There was no significant difference between the postoperative and last follow-up UCVA (0.22±0.14) (t=1.43, P=0.16), and the postoperative visual acuity remained stable. At the last follow-up after surgery, 1 eye had a SE of -1.25 D (reserved for the other eye), 10 eyes with a SE of -1.00 D to -0.50 D, and 51 eyes with a SE of -0.50 to +0.50 D. The preoperative IOP of 62 eyes was (14.20±2.20) mmHg (1 kPa=7.5 mmHg). Among them, 12 eyes began to have increased IOP at 1d after the surgery, reaching (28.0-40.3) mmHg. The main reason was the residual viscoelastic agent in the eye, which leads to secondary glaucoma. After IOP reduction treatment, the IOP returned to the normal range within 3d. The IOP at the last follow-up was (13.92±2.10) mmHg, and there was no significant difference between the preoperative and last follow-up IOP (t=0.25, P=0.90). The ECD of 62 eyes before surgery was (2826.3±489.8) cells·mm^-2, and the last follow-up ECD was (2474.3±397.6) cells·mm^-2, with a significant difference (t=6.82, P=0.00). The ECD in 41 eyes after removing dislocated or intraocular lenses in the first stage and undergoing the anterior chamber iris-claw intraocular lens implantation decreased by 11.25% on average. The ECD in 21 eyes after the anterior chamber iris-claw intraocular lens implantation in the second stage decreased by 5.23% on average. After surgery, a total of 5 eyes had an ECD reduction of over 15%, all of which belonged to the first 5 patients who underwent surgery in the early stage. At the last follow-up, the anterior chamber depth of 62 eyes was (2.40±0.32) mm. Meanwhile, it was found that there was no contact between the periphery of the intraocular lens and the corneal endothelium through the dynamic examination using a slit lamp (anterior segment photography system) and static optical coherence tomography (OCT) examination of the anterior segment. Among the 5 eyes with a postoperative ECD reduction of more than 15%, 3 eyes had one-side dislocation of the intraocular lens loop, and 2 eyes underwent refixation surgery due to the small amount of iris tissue captured by the iris claw. After refixation surgery, the intraocular lens was stable and did not have dislocation again.
Conclusion　The anterior chamber iris-claw intraocular lens implantation can effectively improve visual function and stabilize IOP in aphakic patients without sufficient capsule support in the medium to long term after surgery. During the surgery, the iris-claw intraocular lens loop must be fully connected to the iris tissue to maintain long-term stability. After surgery, long-term attention should be paid to the position of the intraocular lens and changes in the corneal endothelium to prevent a decrease in corneal endothelial cells.