Zhong Liu-Xueying, Zheng Dan-Ying, Sun Yi
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SUN Yat-Sen University, Guangzhou 510060, China.
Zhonghua Yan Ke Za Zhi. 2011 Jan;47(1):45-9.
To study the clinical effects and safety of the auxiliary management with iris retractor for subluxated lens combined with cataract.
Thirty-one eyes lens subluxation with cataract come from 27 patients were reviewed, all of them were 30 - 78 years old and III - IV grade of nuclear. Among these patients, 14 were traumatic cataracts, 12 Marfan syndromes, two over-mature phase of cataracts, one caused suspensory ligament broken during phacoemulsification, and one unclear reason. 1 to 4 iris retractors were used during surgeries, according to the extension of zonular loss and nuclear hardness. Anterior vitrectomy would be taken if vitreous prolapsed. Visual acuities and reactions post-operative were observed, too. And correlation analysis would be used to study the relationship of those objections.
There were no serious complications during the surgeries such as tearing of capsular, falling of nuclear, bleeding of intraocular, and so on. Only 9 of 31 eyes (29.0%) had vitreous prolapsed interoperation, which appeared a significant correlated with range of zonular loss (Spearman r = 0.453, P = 0.010). However, none of them happened during the phacoemulsification for lens nucleus and only 6 eyes took the anterior vitrectomy. The best corrected postoperative visual acuity of these patients attended to 0.2 - 1.2 at a half to 1 month, increased by 1 - 12 lines [average of (6.0 ± 2.7) lines] compared with preoperative. Twenty-three eyes visual acuity of them were no less than 0.5. Corneal edema postoperatively appeared a significant correlated with vitrectomy (Spearman r = 0.398, P = 0.026), while seemed no associated with the range of zonular loss, the number of iris retractors, energy and duration of ultrasound burst or type of intraocular lens (IOL) (P > 0.05).
Phacoemulsification assists with iris retractor can simplify the process of cataract surgery of subluxated lens. Individualized surgical planning and flexible and decisive measures intra-operative achieved good results and well safety in these dangerous and complex lens diseases.
探讨虹膜拉钩辅助处理晶状体半脱位合并白内障的临床效果及安全性。
回顾性分析27例（31眼）晶状体半脱位合并白内障患者的临床资料，患者年龄30～78岁，晶状体核硬度为Ⅲ～Ⅳ级。其中外伤性白内障14例，马方综合征12例，白内障过熟期2例，1例因超声乳化术中悬韧带断裂，1例原因不明。术中根据晶状体悬韧带缺失范围及核硬度使用1～4个虹膜拉钩。若有玻璃体脱出则行前部玻璃体切除术。观察术后视力及反应，并采用相关性分析研究各观察指标之间的关系。
手术中未发生严重并发症，如囊膜撕裂、核坠入、眼内出血等。31眼中仅9眼（29.0%）术中发生玻璃体脱出，其与悬韧带缺失范围呈显著相关（Spearman秩相关系数r = 0.453，P = 0.010）。但在晶状体核超声乳化过程中均未发生，仅6眼行前部玻璃体切除术。术后最佳矫正视力在术后半个月至1个月时达到0.2～1.2，较术前提高1～12行[平均（6.0±2.7）行]。其中23眼视力≥0.5。术后角膜水肿与玻璃体切除术呈显著相关（Spearman秩相关系数r = 0.398，P = 0.026），而与悬韧带缺失范围、虹膜拉钩数量、超声能量及时间或人工晶状体类型无关（P＞0.05）。
超声乳化联合虹膜拉钩可简化晶状体半脱位白内障手术过程。个体化的手术规划及术中灵活果断的处理措施在这些危险复杂的晶状体疾病中取得了良好效果及安全性。
