Garweg J G, Janusic M, Boehnke M, Halberstadt M
Swiss Eye Institute, Clinic for Vitreoretinal Disease, Bern, Switzerland.
Klin Monbl Augenheilkd. 2008 May;225(5):338-41. doi: 10.1055/s-2008-1027254.
Secondary intraocular lens (IOL) implantation is exposed to an increased risk of complications, including endophthalmitis and retinal detachment. The present analysis compares the outcomes and complications experienced in our own series of patients.
We retrospectively reviewed a consecutive series of secondary posterior chamber IOL implantations performed in a single centre, two surgeon setting over a period of 8 years and with a follow up-time of at least 4 months.
Between 1997 and 2005, 75 patients received a sulcus-supported secondary IOL without suture fixation, whereas suture fixation was required in 137 instances. Visual acuity improved in both groups (group 1: from 0.36 +/- 0.39 (0.01-1.2) to 0.73 +/- 0.33 (0.02-1.0; p = 0.18); group 2: from 0.33 +/- 0.34 (0.02-1.0) to 0.46 +/- 0.33 (0.01-1.0; p = 0.006), but more pronounced in eyes not requiring suture fixation (p = 0.012). IOL placement was more likely to be combined with endophacoemulsification in the not suture-fixed IOLs (12.7 vs. 5.3 %). In contrast, retinal tears (10.6 vs. 8.6 %, respectively) and retinal detachment (5.3 vs. 2.2 %, respectively) were equally distributed. In the early postoperative phase, IOP was lower in suture-fixed eyes, which showed a higher incidence of minor intraocular haemorrhages and cystoid macular edema (5.3 vs. 8.0 %); late complications up to 5 years postoperatively were equally distributed.
A preoperatively less complicated anterior segment situation and a lower incidence of postoperative macular edema may account for a better visual outcome after placement of a sulcus supported IOLs without suturing. If required, suture fixation may be performed without exposing the eye to an increased risk of late postoperative complications.
二期人工晶状体（IOL）植入术面临的并发症风险增加，包括眼内炎和视网膜脱离。本分析比较了我们自己系列患者的手术结果和并发症情况。
我们回顾性分析了在单一中心由两位外科医生在8年时间里连续进行的一系列二期后房型IOL植入术患者，随访时间至少4个月。
1997年至2005年期间，75例患者接受了无缝线固定的沟内支撑式二期IOL植入，而137例需要缝线固定。两组视力均有改善（第1组：从0.36±0.39（0.01 - 1.2）提高到0.73±0.33（0.02 - 1.0；p = 0.18）；第2组：从0.33±0.34（0.02 - 1.0）提高到0.46±0.33（0.01 - 1.0；p = 0.006）），但在无需缝线固定的眼中改善更明显（p = 0.012）。在无缝线固定的IOL植入术中，IOL植入更常与超声乳化术联合进行（12.7%对5.3%）。相比之下，视网膜裂孔（分别为10.6%对8.6%）和视网膜脱离（分别为5.3%对2.2%）的分布相当。术后早期，缝线固定眼的眼压较低，微小眼内出血和黄斑囊样水肿的发生率较高（5.3%对8.0%）；术后长达5年的晚期并发症分布相当。
术前眼前节情况较简单且术后黄斑水肿发生率较低，可能是无缝线固定的沟内支撑式IOL植入术后视力改善较好的原因。如有需要，进行缝线固定时不会使眼睛面临更高的术后晚期并发症风险。
