剥脱综合征性白内障综合手术治疗探讨

目的:探讨综合手术治疗剥脱综合征(exfoliation syndrome,XFS)性白内障的有效性及安全性.方法:回顾性分析2012-01/2016-03在喀什地区第二人民医院眼科就诊的剥脱综合征性白内障(exfoliation syndrome combined with cataract,XFSC)患者130例140眼,所有患者均实施综合手术治疗,观察患者术中及术后并发症、术后视力、悬韧带异常发生情况.结果:术中出现小瞳孔、浅前房、前房过深等并发症;术后出现角膜水肿、持续性角膜水肿失代偿、后粘连、黄斑囊样水肿、囊袋皱缩等并发症.术前发现悬韧带异常者有11眼,术中发现悬韧带异常者有27眼.130例患者经综合手术治疗后,出院视力及术后6mo视力均比术前视力有所提高(P<0.05).术后6mo随访患者视力,光感~0.02者5眼;0.03~0.1者15眼;0.12~0.3者27眼;0.4~0.6者83眼;≥0.8者10眼.IOL位置正位129眼,不同程度偏位6眼,脱位5眼.囊袋皱缩17眼.CTR在位32眼,偏移3眼,脱位3眼.治愈120眼,好转15眼,未愈5眼.结论:XFSC手术难度大,完善的术前检查和术中合理有效的处理方法可以减少并发症的发生,有益于术后视功能的恢复.

Surgical treatment of cataract combined with exfoliation syndrome

AIM:To investigate the efficacy and safety of the treatment of exfoliation syndrome combined with cataract (XFSC).METHODS:A retrospective analysis of XFSC in 130 patients (140 eyes) from January 2012 to March 2016.All patients received surgical treatment.Observation of patients with intraoperative complications, postoperative complications, postoperative visual acuity, occur of suspensory ligament abnormalities were taken.RESULTS:The small pupil, shallow anterior chamber, anterior chamber too deep, and other complications appeared during the operations.Postoperative corneal edema, persistent corneal edema decompensation, posterior synechia, cystoid macular edema, capsular shrinkage and other complications appeared.There were 11 eyes of abnormal suspensory ligament before operation, and there were about 27 eyes with this during operations.All the 130 patients were followed up after surgery, the visual acuity when the patients left our hospital and visual acuity of the patients at 6mo after operation were improved compared with the preoperative visual acuity (P<0.05).Postoperative follow-up showed that the visual acuity of 5 eyes were light perception to 0.02, 15 eyes were 0.03-0.1, 27 eyes were 0.12-0.3, 83 eyes were 0.4-0.6, 10 eyes were ≥0.8 at 6 mo after operation.IOL was at normal position in 129 eyes, different degree of deviation in 6 eyes, 5 eyes of dislocation;capsular contraction in 17 eyes;capsular tension ring (CTR) in 32 eyes were at the normal position, 3 eyes with CTR decentration.There were 120 eyes were cured, 15 eyes better, 5 eyes ineffective.CONCLUSION:XFSC surgery is difficult, perfect preoperative examination and reasonable and effective method of treatment can reduce the incidence of complications, beneficial to the recovery of postoperative visual function.