Monteiro M, Marinho A, Borges S, Ribeiro L, Correia C
Department of Ophthalmology, Hospital University of S. João, Porto, Portugal.
J Fr Ophtalmol. 2006 Dec;29(10):1110-7. doi: 10.1016/s0181-5512(06)73906-7.
The purpose of this study was to compare a new intraocular lens (IOL) scleral fixation technique (scleral incision) with the scleral flap surgical technique as regards to efficacy, surgical complications, advantages, disadvantages, and surgery costs in cases with no capsular support.
This was a retrospective study conducted on thirty patients (30 eyes), ten of whom were aphakic, eleven had traumatic cataract, seven had post-phacoemulsification complications, and two had lens luxation. The patients were divided into two groups (I - scleral incision technique and II - scleral flap technique) of fifteen patients each, during a study period lasting eighteen months. The great majority of the procedures were performed under general anesthesia and by the same surgeon. Statistical analysis was done using SPSS. The numerical variables were compared using the t test and the categorical ones using the Fisher exact test. We performed multifactorial analysis to build a model that could predict and compare the complications associated with each technique. An explicative model was built using logistic regression.
We observed a threefold higher rate of complications associated with the scleral flap technique when compared to the scleral incision technique. This difference was particularly relevant as regards the occurrence of free scleral flap and hyphema. No statistically significant differences were observed regarding vitreous hemorrhage, choroidal hemorrhage, retinal detachment, difficulty in the external pulling of the Prolene suture, breaking of the Prolene suture, and anterior chamber collapse. We found a significant association between intraoperative complications and the technique used (higher number of complications with the scleral flap) and also with some systemic diseases (patients with hypertension had more intraoperative complications). The number of late complications resulting from the scleral flap technique was much higher than those observed with the scleral incision technique; however, the number of the cases we studied is insufficient to reach statistical significance.
The duration of the procedure using the IOL scleral incision technique is significantly lower than using the scleral flap technique. Intraoperative complications were significantly associated with the technique used: more frequent with scleral flap. Late complications were mainly associated with systemic and previous ocular diseases.
本研究旨在比较一种新型人工晶状体（IOL）巩膜固定技术（巩膜切口）与巩膜瓣手术技术在无晶状体囊膜支撑病例中的疗效、手术并发症、优缺点及手术成本。
这是一项对30例患者（30只眼）进行的回顾性研究，其中10例为无晶状体眼，11例有外伤性白内障，7例有超声乳化术后并发症，2例有晶状体脱位。在为期18个月的研究期间，患者被分为两组（I组 - 巩膜切口技术和II组 - 巩膜瓣技术），每组15例。绝大多数手术在全身麻醉下由同一位外科医生进行。使用SPSS进行统计分析。数值变量采用t检验进行比较，分类变量采用Fisher精确检验进行比较。我们进行多因素分析以建立一个能够预测和比较与每种技术相关并发症的模型。使用逻辑回归建立一个解释模型。
与巩膜切口技术相比，我们观察到巩膜瓣技术相关并发症的发生率高出三倍。这种差异在游离巩膜瓣和前房积血的发生方面尤为明显。在玻璃体出血、脉络膜出血、视网膜脱离、普理灵缝线外部牵拉困难、普理灵缝线断裂和前房塌陷方面未观察到统计学上的显著差异。我们发现术中并发症与所使用的技术（巩膜瓣并发症数量更多）以及一些全身性疾病（高血压患者术中并发症更多）之间存在显著关联。巩膜瓣技术导致的晚期并发症数量远高于巩膜切口技术观察到的数量；然而，我们研究的病例数量不足以达到统计学意义。
使用IOL巩膜切口技术的手术时间明显低于使用巩膜瓣技术。术中并发症与所使用的技术显著相关：巩膜瓣更频繁。晚期并发症主要与全身性和既往眼部疾病相关。
