Benayoun Y, Petitpas S, Turki K, Adenis J-P, Robert P-Y
Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex 1, France.
J Fr Ophtalmol. 2013 Oct;36(8):658-68. doi: 10.1016/j.jfo.2012.09.009. Epub 2013 Jul 25.
To report the results of a technique of sutureless intrascleral fixation of a three-piece foldable hydrophobic acrylic posterior chamber intraocular lens (PC IOL) in the absence of capsular support and to compare our results to those reported in the literature.
We report a single-center (Limoges University Medical Center) retrospective series of nine patients with deficient posterior capsular support who underwent sutureless sulcus fixation of a hydrophobic acrylic Tecnis Aspheric(®) model ZA9003 (AMO, Inc.) PCIOL using permanent incarceration of the haptics in scleral tunnels parallel to the limbus, between November 2010 and November 2011. All patients were evaluated for surgical indications, pre- and postoperative refractive status (visual acuity and corneal cylinder), and intra- and postoperative complications.
We included six men and three women with post-traumatic subluxed IOL's in three cases and lack of iris and capsular support secondary to traumatic corneoscleral wounds in six cases. Mean age was 63.22 ± 18.79 years. Posterior vitrectomy was performed in all cases. Mean 3-month postoperative visual acuity was 0.42 ± 0.16 LogMAR, and mean corneal postoperative astigmatism was 1.39 ± 0.78 diopters. Complications included IOL decentration of 1.5mm in one case, haptic rupture requiring intraoperative IOL exchange in one case, and transitory postoperative macular edema in two cases.
Artificial intraocular lens implantation in the absence of capsular support is always a surgical challenge. Currently, the two most widely used approaches include fixation to the iris by suturing or iris claw, and fixation to the sclera with sutures. However, these techniques require wide corneal or scleral incisions resulting in significant postoperative astigmatism. Furthermore, iris fixation is impossible in cases of significant iris trauma, and scleral sutures are often technically difficult and expose the patient to late IOL dislocation or tilt. Sutureless intrascleral fixation of foldable hydrophobic acrylic three-piece IOL's inserted through a conventional sub-2.8mm clear corneal incision is a recent technique. This technique is compatible with cases of iris trauma and allows sutureless fixation of the haptics in scleral tunnels parallel to the limbus, while minimizing the risk of postoperative astigmatism. In addition, it allows the repositioning of IOL's dislocated into the vitreous without re-opening the corneal incision. Complications are mainly related to IOL manipulation and positioning.
Results obtained after sutureless intrascleral PCIOL implantation showed good visual outcomes with minimal complications in eyes with deficient capsular support.
报告在无囊膜支撑情况下，三件式可折叠疏水丙烯酸后房型人工晶状体（PC IOL）无缝线巩膜内固定技术的结果，并将我们的结果与文献报道的结果进行比较。
我们报告了一个单中心（利摩日大学医学中心）的回顾性系列研究，9例后囊膜支撑不足的患者于2010年11月至2011年11月间，接受了使用永久嵌顿襻于平行于角膜缘的巩膜隧道内的方法，对疏水丙烯酸Tecnis非球面（®）型号ZA9003（AMO公司）PC IOL进行无缝线沟内固定术。所有患者均评估了手术适应症、术前和术后屈光状态（视力和角膜散光）以及术中和术后并发症。
我们纳入了6名男性和3名女性，其中3例为创伤后人工晶状体半脱位，6例因创伤性角巩膜伤口导致虹膜和囊膜支撑缺失。平均年龄为63.22±18.79岁。所有病例均进行了后玻璃体切除术。术后3个月平均视力为0.42±0.16 LogMAR，术后平均角膜散光为1.39±0.78屈光度。并发症包括1例人工晶状体偏心1.5mm，1例襻破裂需术中更换人工晶状体，2例术后短暂性黄斑水肿。
在无囊膜支撑情况下植入人工晶状体始终是一项手术挑战。目前，两种最广泛使用的方法包括通过缝合或虹膜爪固定于虹膜，以及用缝线固定于巩膜。然而，这些技术需要较宽的角膜或巩膜切口，导致明显的术后散光。此外，在虹膜严重创伤的情况下无法进行虹膜固定，巩膜缝线在技术上往往困难，且使患者面临人工晶状体晚期脱位或倾斜的风险。通过传统的2.8mm以下透明角膜切口插入的可折叠疏水丙烯酸三件式人工晶状体的无缝线巩膜内固定是一项新技术。该技术适用于虹膜创伤的病例，允许将襻无缝线固定于平行于角膜缘的巩膜隧道内，同时将术后散光风险降至最低。此外，它允许将脱位至玻璃体的人工晶状体重新定位而无需重新打开角膜切口。并发症主要与人工晶状体的操作和定位有关。
无缝线巩膜内植入PC IOL后获得的结果显示，在囊膜支撑不足的眼中视觉效果良好，并发症最少。
