Tassignon Marie-José, Bartholomeeusen Ellen, Rozema Jos J, Jongenelen Sien, Mathysen Danny G P
Department of Ophthalmology, Antwerp University Hospital, Edegem, Antwerp, BelgiumDepartment of Ophthalmology, University of Antwerp, Antwerp, Belgium.
Acta Ophthalmol. 2014 May;92(3):265-9. doi: 10.1111/aos.12093. Epub 2013 May 7.
Our purpose was to evaluate the surgical outcome after intra-ocular lens exchange in patients who presented impairing visual complaints after primary multifocal intra-ocular lens (MIOL) implantation. In particular, the study was undertaken to look at the number of eyes that could be equipped with the bag-in-the-lens (BIL) IOL after MIOL exchange.
This series consisted of 30 eyes of 21 consecutive patients scheduled for MIOL exchange. In 15 out of the 30 eyes, IOL misalignment was measured on slit lamp anterior segment photo's after defining the mathematical centres of the IOL optic, pupil and limbus.
Diffractive MIOL was more frequently explanted (25; 83%) when compared with refractive MIOL (4; 13%) and progressive optic IOL (1; 4%). In 21 out of the 30 eyes (70%) a bag-in-the-lens could be implanted. In 7 out of the 30 eyes (23%), the capsule was not considered sufficiently stable to accommodate an IOL. An iris-fixated IOL or a sulcus-fixated IOL was then implanted. In 2 out of the 30 eyes (6%) the remaining capsular bag could accommodate a traditional lens-in-the-bag only. Eyes that underwent Nd:YAG laser capsulotomy prior to the MIOL exchange needed anterior vitrectomy peroperatively (11 eyes; 37%). Visual acuity improved postoperatively in 13 out of the 30 eyes and remained stable in 17 out of the 30 eyes.
Since the BIL technique requires a very well-preserved capsular bag for the purpose of the IOL implantation, the success rate of BIL implantation after MIOL is a good indicator to evaluate the degree of difficulty to exchange MIOL.
我们的目的是评估在初次植入多焦点人工晶状体（MIOL）后出现视力受损主诉的患者进行人工晶状体置换术后的手术效果。特别是，本研究旨在观察MIOL置换后可植入囊内晶状体（BIL）人工晶状体的眼数。
本系列包括21例连续患者计划进行MIOL置换的30只眼。在30只眼中的15只眼中，在确定人工晶状体光学部、瞳孔和角膜缘的数学中心后，通过裂隙灯前段照片测量人工晶状体的偏心情况。
与折射型MIOL（4只；13%）和渐进性光学人工晶状体（1只；4%）相比，衍射型MIOL更常被取出（25只；83%）。30只眼中有21只（70%）可以植入囊内晶状体。30只眼中有7只（23%），认为囊袋不够稳定，无法容纳人工晶状体。然后植入虹膜固定型人工晶状体或睫状沟固定型人工晶状体。30只眼中有2只（6%）剩余的囊袋仅能容纳传统的囊袋内人工晶状体。在MIOL置换术前接受Nd:YAG激光囊膜切开术的眼术中需要进行前部玻璃体切割术（11只眼；37%）。30只眼中有13只术后视力提高，30只眼中有17只保持稳定。
由于BIL技术为了植入人工晶状体需要保存非常完好的囊袋，MIOL术后BIL植入的成功率是评估MIOL置换难度的一个良好指标。
