先天性晶状体脱位31例的手术治疗观察

目的：通过对先天性晶状体脱位行手术治疗的患者进行临床分析及手术方式选择、手术后效果分析，探讨先天性晶状体脱位患者的手术方式的选择及术中术后并发症的防治。
　　方法：回顾性分析我院自2010-01-01/2015-01-01的5 a间先天性晶状体脱位行手术治疗的患者共31例57眼，进行临床分析及手术方式选择、手术后效果、并发症分析。
　　结果：先天性晶状体脱位临床最常见的类型为单纯性晶状体半脱位和Marfan综合征晶状体半脱位。57眼中1眼为Marchesani综合征继发性青光眼导致视神经萎缩，术后视力无改善，其余56眼(98%)术后视力均较术前有不同程度提高。手术方式：晶状体超声乳化摘除+人工晶状体植入术3眼(5%)；晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术8眼(14%)，其中1眼行囊袋张力环巩膜缝合固定；经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术39眼(68%)，其中2眼联合小梁切除术，未植入人工晶状体；晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术5眼(9%)；经睫状体平坦部切口晶状体切除联合玻璃体切除术+硅油注入术2眼(4%)。
　　结论：先天性晶状体脱位经过手术治疗大多数患者均可取得较为满意的术后效果。对于晶状体半脱位范围<90°者，可单纯行晶状体超声乳化摘除+人工晶状体植入术；晶状体半脱位范围90°~180°者，行晶状体超声乳化摘除+囊袋张力环植入+人工晶状体植入术；晶状体半脱位范围>180°者，经角膜切口晶状体切除联合前部玻璃体切除+人工晶状体缝线固定术，术后效果优于晶状体囊内摘除联合前部玻璃体切除+人工晶状体缝线固定术；根据患者晶状体脱位程度，尽量选择切口较小的微创的手术方式是手术取得成功的关键。

Clinical observation of 31 patients of congenital ectopia lentis treated with different operative manipulations

AIM: To determine the optimal operation method and reduce operative complications by retrospective analysis of outcomes of different operative manipulation for patients with congenital ectopia lentis(CEL).

METHODS: A retrospective study ranged from Jan. 1, 2010 to Jan. 1, 2015 was conducted and 31 CEL patients(57 eyes)treated with different operations were taken into this study. The postoperative outcome, operation related complications was analyzed in terms of different operative manipulations.

RESULTS: The most common types of CEL are idiopathic and Marfan-related CEL. All eyes(98%)benefited from operation except 1 Marchesani syndrome eye concurrent with optic atrophy induced by glaucoma. A total of 3 eyes(5%)were treated by phacoemulsification combined with intraocular lens implantation; 8 eyes(14%)were treated by phacoemulsification, capsular tension ring implantation combined with intraocular lens implantation, among these 8 eyes, 1 eye was treated with capsular tension ring implantation combined with suture fixation; 39 eyes(68%)were treated by lens excision and anterior vitrectomy through corneal incision combined with intraocular lens implantation with suture fixation, among these 39 eyes, 2 eyes were treated with trabeculectomy, but not combined with intraocular lens implantation; 5 eyes(9%)were treated by intracapsular cataract extraction and anterior vitrectomy combined with intraocular lens implantation with suture fixation; 2 eyes(4%)were treated by lens excision and vitrectomy through pars plana combined with silicon oil injection.

CONCLUSION: Almost all patients can obtain satisfactory outcomes through various operative manipulations. Phacoemulsification combined with intraocular lens implantation was the first choice for patients with lens dislocation range less than 90°. Phacoemulsification, capsular tension ring implantation combined with intraocular lens implantation was recommended for 90°-180°, and lens excision and anterior vitrectomy through corneal incision combined with intraocular lens implantation with suture fixation was more suitable for lens dislocation range more than 180°. The appropriate operative methods for different types of CEL patients is the key to success.