人工晶体异位77例临床分析

目的探讨人工晶体脱位与半脱位的病因、临床表现及防治方法。方法对我科1997年1月-2005年12月收治的77例（81眼）人工晶体脱位与半脱位病例的临床资料进行回顾性分析。结果77例81只人工晶体脱位与半脱位眼中,前房型人工晶体1只眼,后房型人工晶体80只眼。人工晶体异位的情况瞳孔夹持52只眼,脱入玻璃体腔15只眼,“日落”综合征8只眼,“日出”综合征4只眼,脱出眼外2只眼。人工晶体异位的原因及诱因包括术中有晶体后囊膜破裂,玻璃体脱出,人工晶体未植入囊袋内;术后葡萄膜炎;外伤;晶体悬韧带断裂。治疗方法11只眼观察,4只眼保守治疗,14只眼行人工晶体复位术,27只眼行虹膜前后粘连分离、人工晶体复位、后囊膜切开术,8只眼行人工晶体取出术,17只眼行人工晶体置换术。治疗效果术后绝大多数眼的视力提高或保持不变。手术并发症包括视网膜脱离、前房积血及前房玻璃体积血各1例。结论儿童人工晶体植入术后人工晶体夹持是人工晶体异位的主要类型,应引起临床医生的高度重视;手术操作不当是导致人工晶体脱位的直接原因。提高手术质量,减少术中、术后并发症,将人工晶体植入囊袋内是避免人工晶体异位的根本措施。

Dislocation of Intraocular Lenses in 77 Cases

Objective:To evaluate the etiology,clinical manifestations and treatment of dislocation of intraocular lenses(IOL).Methods:The clinical data of 77 patients with dislocation of IOL were retrospectively analyzed.Results:Among the 81 eyes with dislocated IOL,anterior chamber IOL in l and posterior chamber IOL in 80.The dislocated IOL included pupillary capture in 52 eyes,dislocation into the vitreous cavity in 15 eyes,sunset or sunrise syndromes in 12 eyes,extrusion from the eyeball in 2 eyes.in IOL dislocations were caused by capsular ruprure,vitreous loss or out of the capsular IOL implantation during operation,postoperative uveitis,zonal fibers rupture due to trauma or high myopia.11 eyes were under observation.18 eyes underwent IOL repositioning including 4 eyes without operation and 14 eyes with operation.27 eyes were performed dissection of pupillary synnechia,IOL repositioning and posterior capsulotomy.optraction in 8 eyes and replacement in 17 eyes.The visual acuity correction after operation was the same as before but increased in most eyes.Conclusion:Pupillary capture in children was the most common type of IOL dislocation.The poor operative procedure was the direct reason for IOL dislocation.Meticulous surgical technique in the capsular IOL implantion and minimal operation complications were the most important factors in avoiding IOL dislocation.