Praveen M R, Vasavada Abhay R, Singh Raminder
Iladevi Cataract and IOL Research Centre, Ahmedabad, India.
Indian J Ophthalmol. 2003 Jun;51(2):147-54.
To evaluate the outcome of phacoemulsification in eyes with subluxated cataract.
This retrospective study comprised 22 eyes of 20 consecutive patients with subluxated cataracts of varying aetiology operated between March 1998 and March 2001. Detailed preoperative assessment included visual acuity (VA), slitlamp examination, presence of vitreous in anterior chamber extent of subluxation, intraocular pressure (IOP) and detailed fundus examination. Phacoemulsification was done to retain the natural bag support and all patients had acrylic foldable Acrysof IOL implantation either in-the-bag or by scleral fixation. Postoperative observations included best-corrected visual acuity (BCVA), IOP, pupillary reaction and the IOL position.
The aetiology of the subluxation was traumatic in 11 patients and non-traumatic in 9 patients. Fifteen were males and 5 were females. Mean follow-up was 11.7 +/- 9.71 months (range 4-39). The average age was 39.15 +/- 16.33 (range 5-74). A 2-port anterior chamber vitrectomy was performed in 6 eyes (27.2%). Capsule tension ring (CTR) was implanted in 15 eyes (68.18%). Twelve eyes (54.5%) had in-the-bag implants, while 5 (22.72%) had scleral fixation. The remaining 5 eyes (22.72%) had one haptic in-the-bag and another sutured to sclera. No major intraoperative complications were noted. Twelve eyes (54.5%) had clinically and geometrically well centered IOLs while 9 eyes (40.9%) had geometrically decentered IOLs. One patient was lost to follow-up. Fifteen eyes (55.55%) had postoperative BCVA of 6/12 - 6/6 while 2 eyes (7.40%) had BCVA of 6/18. The remaining 4 eyes (14.81%) had less than 6/24 BCVA due to pre-existing posterior segment pathology. Postoperative complications included rise in IOP in 1 eye (4.54%), pupillary capture of the IOL optic in 2 eyes (9.09%); the same 2 eyes (9.09%) required redialing of IOL. One eye (4.54%) had to undergo refixation (one haptic was fixed to sclera) year after cataract surgery. Postoperative retinal detachment was noticed in one patient after a month of phacoemulsification.
In subluxated cataracts it is essential to have appropriate parameters depending on the grade of cataract. This contributes to a safe and predictable outcome in subluxated cataract surgery.
评估超声乳化白内障吸除术治疗晶状体半脱位白内障的效果。
本回顾性研究纳入了1998年3月至2001年3月间连续20例病因各异的晶状体半脱位白内障患者的22只眼。详细的术前评估包括视力（VA）、裂隙灯检查、前房内玻璃体的存在情况、半脱位范围、眼压（IOP）以及详细的眼底检查。采用超声乳化白内障吸除术以保留自然晶状体囊袋支撑，所有患者均植入了丙烯酸可折叠式Acrysof人工晶状体，要么植入囊袋内，要么通过巩膜固定。术后观察指标包括最佳矫正视力（BCVA）、眼压、瞳孔反应及人工晶状体位置。
半脱位的病因在11例患者中为外伤性，9例为非外伤性。男性15例，女性5例。平均随访时间为11.7±9.71个月（范围4 - 39个月）。平均年龄为39.15±16.33岁（范围5 - 74岁）。6只眼（27.2%）进行了2端口前房玻璃体切除术。15只眼（68.18%）植入了囊袋张力环（CTR）。12只眼（54.5%）植入了囊袋内人工晶状体，5只眼（22.72%）进行了巩膜固定。其余5只眼（22.72%）一只襻植入囊袋内，另一只襻缝合至巩膜。术中未发现重大并发症。12只眼（54.5%）的人工晶状体在临床和几何位置上居中良好，而9只眼（40.9%）的人工晶状体几何位置偏心。1例患者失访。15只眼（55.55%）术后最佳矫正视力为6/12 - 6/6，2只眼（7.40%）最佳矫正视力为6/18。其余4只眼（14.81%）因术前存在后段病变，最佳矫正视力低于6/24。术后并发症包括1只眼（4.54%）眼压升高，2只眼（9.09%）人工晶状体光学部发生瞳孔夹持；同样这2只眼（9.09%）需要调整人工晶状体位置。1只眼（4.54%）在白内障手术后1年不得不进行重新固定（一只襻固定至巩膜）。1例患者在超声乳化白内障吸除术后1个月出现视网膜脱离。
对于晶状体半脱位白内障，根据白内障的分级确定合适的参数至关重要。这有助于晶状体半脱位白内障手术获得安全且可预测的结果。
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