33例人工晶状体置换术的临床分析

目的 探讨人工晶状体置换术的原因、特点、处理方式和效果。方法 收集2014 年9 月～2018 年7 月间在我院白内障专科行人工晶状体置换术的33 例33 眼资料，按置换原因分类，回顾分析其临床特点，包括病史特点、人工晶状体置换情况、术后效果及术后并发症。结果 人工晶状体置换主要原因为人工晶状体位置异常、屈光误差或意外及人工晶状体混浊。人工晶状体位置异常21 例（63.6%），占比超过一半，其中人工晶状体脱位17 例（51.5%），行人工晶状体置换后视力较术前有所好转，除术后出现黄斑囊样水肿1 例、继发性青光眼1 例，余无并发症；人工晶状体夹持3 例（9.1%）、人工晶状体倾斜偏中心1 例（3.0%），置换后均无并发症产生；屈光意外或漂移9 例（27.2%），行人工晶状体置换后屈光度均改善，均无严重并发症；因植入多焦点人工晶状体后，患者对视觉质量不满，置换成单焦点人工晶状体2 例（6.1%），术后效果满意；人工晶状体混浊1 例（3.0%），置换后视力为0.8，无并发症。结论 术后人工晶状体位置异常是人工晶状体置换最常见的原因，其次是屈光意外，主要存在于先天性白内障患者和有屈光手术史患者群中，合理把握人工晶状体置换手术指征、掌握手术操作技巧，人工晶状体置换术可有效改善患者视力、提高患者满意度。

Clinical analyses of 33 cases of intraocular lens replacement

Objective To explore the causes,features,treatments and efficacies of intraocular lens(IOL) replacement.Methods The data of 33 cases(33 eyes) who underwent IOL replacement admitted to the department of cataract in our hospital from September 2014 to July 2018 were collected.According to the reasons of replacement,the clinical features were analyzed retrospectively,including features of medical history,IOL replacement,postoperative efficacy and incidence of complications.Results Abnormal position of IOL,refractive error or accident,and opacity of IOL were included in the main reasons of IOL replacement.There were 21 cases(63.6%) with abnormal position of IOL,accounting for more than half of them.Among them,17 cases(51.5%) were dislocation of IOL.After IOL replacement,the visual acuity was better than that before operation,except 1 case of postoperative macular cystoid edema and 1 case of sec ondary glaucoma,and there was no complication in the rest.There were 3 cases (9.1%) of IOL clamping and 1 case(3.0%) of IOL inclining to the center.No complications occurred after replacement.There were 9 cases(27.2%) suffered from refractive accident or drift,and all the diopters were improved after IOL replacement without serious complications.After implantation of multifocal IOL,the patients were dissatisfied with the visual quality.Meanwhile,2 cases(6.1%) were replaced with monofocal IOL,and the postoperative efficacy was satisfying.There was 1 case(3.0%) of opacified IOL,and the visual acuity after replacement was 0.8,without any complication.Conclusion The abnormal position of IOL after operation is the most common cause of IOL replacement,followed by refractive accident,which mainly exists in patients with congenital cataract and those with a history of refractive surgery.Reasonable grasp of IOL replacement operation indexes and surgical skills can effectively improve the visual acuity of patients and raise their satisfaction.