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引用:杨晋,叶鸿飞,邱晓頔,蔡蕾,卢奕.借助显微镜照明直视下单通道经睫状体平坦部玻璃体切割术治疗人工晶状体脱位.国际眼科杂志 2020;20(8):1299-1303,doi:10.3980/j.issn.1672-5123.2020.8.01
借助显微镜照明直视下单通道经睫状体平坦部玻璃体切割术治疗人工晶状体脱位
Managing intraocular lens dislocation with one-port pars plana vitrectomy under direct vision with microscope illumination
投稿时间:2019-12-30  修订日期:2020-05-26
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DOI:10.3980/j.issn.1672-5123.2020.8.01
关键词:  人工晶状体脱位  单通道  经睫状体平坦部玻璃体切割术  白内障手术
Key Words:  intraocular lens dislocation  one-port  pars plana vitrectomy  cataract surgery
基金项目:国家自然科学基金(No.81670835); 上海市高度近视研究(No.NCT03062085)
Fund Project:National Natural Science Foundation of China(No.81670835); Shanghai High Myopia Study(No.NCT03062085)
              
作者单位
杨晋 中国上海市, 复旦大学附属眼耳鼻喉科医院眼科; 中国上海市, 卫生部近视眼重点实验室
叶鸿飞 中国上海市, 上海交通大学医学院附属新华医院眼科*:杨晋与叶鸿飞对本文贡献一致。
邱晓頔 中国上海市, 复旦大学附属眼耳鼻喉科医院眼科; 中国上海市, 卫生部近视眼重点实验室
蔡蕾 中国上海市, 复旦大学附属眼耳鼻喉科医院眼科; 中国上海市, 卫生部近视眼重点实验室
卢奕 中国上海市, 复旦大学附属眼耳鼻喉科医院眼科; 中国上海市, 卫生部近视眼重点实验室
              
AuthorInstitution
Jin Yang Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai , China; Myopia Key Laboratory of Health PR China, Shanghai , China
Hong-Fei Ye Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai , China
Xiao-Di Qiu Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai , China; Myopia Key Laboratory of Health PR China, Shanghai , China
Lei Cai Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai , China; Myopia Key Laboratory of Health PR China, Shanghai , China
Yi Lu Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai , China; Myopia Key Laboratory of Health PR China, Shanghai , China
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目的:描述一种显微镜照明直视下、经单通道睫状体平坦部行玻璃体切割术治疗人工晶状体全脱位至玻璃体腔的手术技术。

     方法:收集2013年至今经超声乳化白内障摘除术后自发性人工晶状体(IOL)囊外脱位或IOL复合体脱位至玻璃体腔的病例。术后随访至6mo。本文详细描述了该手术技术,并回顾性总结了8例典型病例。

     结果:共40例患者接受了该手术方法。与IOL全脱位至玻璃体腔相关的危险因素包括:玻璃体切除手术史、超声乳化术中后囊膜破裂或悬韧带断裂、既往眼部外伤史、长眼轴、Ⅱ期IOL植入、陈旧性葡萄膜炎、视网膜色素变性、或抗青光眼手术史。术中所有患者的IOL均顺利取出。随访期内未发生与手术步骤相关的术中或术后并发症。术前患者的最佳矫正视力(CDVA)位于20/133至20/25间,末次随访时(术后6mo)基本持平。眼压值均位于正常范围。

     结论:显微镜照明直视下单通道玻璃体切割术是一种处理IOL脱位的相对简单、安全有效的手术方法,其能缩短手术时间,并大大减少手术相关并发症的发生。

Abstract:
      AIM: To describe a technique of managing intraocular lens(IOL)with deep dislocation in the vitreous cavity by performing pars plana vitrectomy(PPV)with only one pars plana incision under the direct illumination of the surgical microscope.

     METHODS: Patients who had in-the-bag or out-of-the-bag(spontaneous)IOL dislocation after uneventful phacoemulsification cataract extractions, with the dislocated IOL or IOL-capsular bag complex dropping completely into the vitreous since 2013 were included in our studies. The postoperative patients were followed up for 6mo. Detailed description of technique and retrospective description of eight typical cases were demonstrated in this study.

     RESULTS:A total of 40 surgeries were conducted using this technique. The main possible predisposing conditions included: post-vitrectomy, posterior capsule rupture or broken zonules, a history of ocular trauma, long axial length, secondary IOL implantation, chronic uveitis, retinitis pigmentosa and post-glaucoma surgery. In all eyes, the IOLs were successfully removed. No intraoperative or postoperative complications related to the procedures occurred. The preoperative corrected distance visual acuity(CDVA)ranged from 20/133 to 20/25, and at 6mo postoperatively, the CDVA was similar or the same. The intraocular pressure was all within the normal range.

     CONCLUSION: One-port PPV under direct vision with microscope illumination is a simple and safe surgical technique to managing IOL dislocation, which shortens the surgical time, and largely avoids surgical complications.

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