飞秒激光联合Cionni张力环植入治疗外伤性晶状体不全脱位的有效性和安全性

目的:探讨飞秒激光辅助晶状体超声乳化吸除联合Cionni 改良张力环(MCTR)植入治疗外伤性晶状体不全脱位的有效性和安全性.方法:外伤性晶状体不全脱位患者11例11眼,90°≤脱位<120° 4眼,120°≤脱位<180° 5眼,180°≤脱位<270° 2眼.应用接触式LenSx飞秒激光白内障手术操作平台完成前囊膜切开、晶状体预劈核、切口制作.部分患者行前段玻璃体切割.囊袋拉钩稳定囊袋,超声乳化白内障吸除,MCTR植入及巩膜层间缝合固定,晶状体囊袋内植入IOL.分析术后视力、术中术后并发症、前囊口、IOL和MCTR位置及眼压情况.结果:随访2mo.所有患者均顺利完成手术,其中5眼联合前段玻璃体切割术.植入双钩MCTR 4眼,单钩7眼.术后术眼最佳矫正视力≥0.5者4眼,0.3~<0.5者3眼,0.1~<0.3者3眼,<0.1者1眼.与术前矫正视力比较,差异有统计学意义(P<0.05).所有IOL位置居中,MCTR固定钩稳定地位于虹膜与晶状体囊膜间.术中、术后常见并发症为结膜下出血、前囊切开不完全、皮质残留、继发性青光眼和后囊膜混浊.结论:飞秒激光辅助白内障超声乳化吸除可以提高撕囊成功率,降低核乳化吸除难度,联合MCTR植入是外伤性晶状体不全脱位手术的理想术式选择.

Safety and effect of femtosecond laser-assisted cataract surgery combined with Cionni capsular tension ring implantation in the management of traumatic lens subluxation

AIM:To investigate the safety and effect of femtosecond laser-assisted cataract surgery with Cionni modified capsular tension ring(MCTR)implantation in the management of traumatic lens subluxation.

METHODS: Totally 11 patients(11 eyes)with traumatic lens subluxation were divided into three groups according to the severity of lens dislocation, ranging from 90° to 120°(4 eyes), 120° to 180°(5 eyes)and 180° to 270°(2 eyes). The contact LenSx femtosecond laser cataract surgery platform was applied to create the capsulotomy, prepare nuclear fragmentation and make corneal wound creation. Anterior vitrectomy was performed in some patients during the surgery. After capsular retractors insertion and phacoemulsification, the MCTR was inserted to the capsular bag and fixed to the sclera. Finally, the IOL was implanted into the capsular bag. Postoperative visual acuity, intra- and post-operative complications, anterior capsular opening, IOL and MCTR position and intraocular pressure(IOP)were assessed.

RESULTS:The duration of follow-up was 2mo. All the operations were completed successfully. Five eyes underwent cataract surgery combined with anterior vitrectomy. Four eyes had been inserted with 2-eyelet MCTR and seven eyes with 1-eyelet MCTR. The best corrected visual acuity(BCVA)after operation was better than 0.5 in 4 eyes, between 0.3 and 0.5 in 3 eyes, between 0.1 and 0.3 in 3 eyes, and less than 0.1 in 1 eye. Compared with preoperative BCVA, the difference was statistically significant(P<0.05). All the IOLs were stably centered and the eyelet of MCTR was fixated steadily between the iris and the anterior capsule. The common intra- and post-operative complications were subconjunctival hemorrhage, incomplete capsulotomy, residual cortex, secondary glaucoma and posterior capsular opacification.

CONCLUSION:Femtosecond laser-assisted cataract surgery can improve the success rate of capsulorhexis, and reduce the difficulty of nuclear fragmentation. Femtosecond laser-assisted cataract surgery combined with MCTR implantation is an ideal surgical method for traumatic lens subluxation.