后房型有晶状体眼人工晶状体外伤性脱位

目的 研究后房型有晶状体眼人工晶状体（PC—PIOL）植入术后外伤致其脱位的临床特点及治疗原则。方法 我院PC-PIOL植人手术矫正高度近视42例（80眼）中2例（2眼）因眼外伤导致PC-PIOL脱位。1眼系植入可植入式隐形眼镜（ICL）术后8个月不全脱位于前房；另1眼系植入后房型有晶状体眼屈光晶状体（PC—PRL）术后3个月全脱位于前房。两例分别于外伤后1d、3d接受PC-PIOL的复位手术。比较术前术后角膜内皮细胞计数的不同。2例术后观察均在6个月以上。结果 PC-PIOL脱位于前房患者主觉眼部轻度不适，视力下降。检查可见房水闪光明显，瞳孔变形，人工晶状体被瞳孔夹持。手术复位后视力恢复，遗留瞳孔变形。另1例ICL不全脱位后裸眼视力为0．2，复位术后为0．3。PC-PRL全脱位后裸眼视力为0．3，术后恢复至1．0，术后最佳矫正视力均未下降。2例均未发生白内障等并发症。2例脱位后角膜内皮细胞计数分别为1941／mm^2和1889／mm^2，手术复位后1周角膜内皮计数分别为1883／mm^2和1746／mm^2，手术复位后6个月角膜内皮计数分别为1911／mm^2和1845／mm^2。结论 眼外伤可导致PC-PIOL全脱位或不全脱位于前房，引起前部葡萄膜反应，瞳孔变形，还可导致角膜内皮细胞计数下降。立即手术复位安全有效，但应长期随访角膜内皮细胞计数变化。

Posterior chamber phakic intraocular lens dislocation after ocular trauma

Objective To study the clinical features and treatment principles of posterior chamber phakic intraocular lens （PC-PIOL） dislocation after ocular trauma. Methods Eighty eyes of 42 eases had undergone PC-PIOL implantation for the correction of high myopia, in which two cases were found PC-PIOL dislocation after ocular trauma. One case who received implantable collamer lens （ICL） implantation 8 months ago was diagnosed ICL subluxation into the anterior chamber after ocular blunt trauma. Another case who received posterior chamber phakic refractive lens （PC-PRL）implantation 3 months ago was found dislocation into anterior chamber after trauma. The operations for PC-PIOL reposition were performed 1 and 3 days respectively after the trauma. The endothelial cell density （ECD） count was documented and compared. The two eases were followed-up for 6 months. Results The clinical features of PC-PIOL dislocation after ocular trauma included mild discomfort, visual acuity decrease, aqueous flare, pupil deformation and pupillary capture of IOL. The uncorrected visual acuity （ UCVA ） of ICL subluxation eye decreased to O. 2 after trauma, and it was recovered to 0.3 after reposition surgery. The UCVA for PC-PRL dislocation eye decreased to 0.3 after tramna, and regained to 1.0 after reposition surgery. Neither of the two cases had best corrected visual acuity （BCVA） loss. There was no complications such as traumatic cataract occurred. The ECD count of the two cases dropped to 1941/mm^2 and 1889/mm^2 respectively. It continuously dropped to 1883/mm^2 and 1746/mm^2 at one week after the reposition surgery, but it went upward to 1911/mm^2 and 1845/mm^2 at 6 months postoperatively. Conclusion PC-PIOL for high myopia could be subluxated or dislocated into anterior chamber after ocular trauma, led to aqueous flare, pupil deformation and ECD loss. The immediate PC-PIOL reposition was safe and effective, and long term ECD follow-up was suggested.