Yan Hua
Medical University General Hospital, Tianjin 300052, China. Email:
Zhonghua Yan Ke Za Zhi. 2014 Feb;50(2):105-8.
To explore the time and method of secondary intraocular lens (IOL) implantation in open-globe injury after vitrectomy and to analyze the efficacies and relative factors of the treatment.
This is a retrospective case series study. Clinical data of 78 eyes of 78 patients with open-globe injury who underwent secondary IOL implantation after vitrectomy in Tianjin Medical University General Hospital from 2007 to 2012 were analyzed. There were 27 eyes of 27 patients with penetrating injury, 36 eyes of 36 patients with intraocular foreign body (IFB), 4 eyes of 4 patients with ocular rupture, and 11 eyes of 11 patients with endophthalmitis. The IFB included magnetic foreign body in 23 eyes of 23 patients, glass foreign body in 6 eyes of 6 patients, and eyelash foreign body in 7 eyes of 7 patients. Thirty-one eyes of 31 patients were tamponade with silicone oil, and 47 eyes of 47 patients were tamponade with C3F8 during vitrectomy. The methods of IOL implantation included posterior chamber IOL implantation in 32 eyes of 32 patients and sulcus-fixed IOL implantation in 46 eyes of 46 patients. The examinations before IOL implantation mainly included visual acuity, slit lamp biomicroscope, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope and intraocular pressure. Four eyes of 4 patients underwent suturing of peripheral iris, and 5 eyes of 5 patients underwent suturing of iris laceration. The visual acuity ranged from light perception to 0.1 before vitrectomy. The mean follow-up time was 15 ± 3 months with a range from 6 to 36 months.
The mean interval between IOL implantation and vitrectomy was 2.5 ± 0.2 months with a range from 1.5 to 6 months. The best corrected visual acuity was from 0.1 to 1.0 after vitrectomy. The uncorrected visual acuity ranged from 0.1 to 0.8, and the best corrected visual acuity was from 0.1 to 1.0 after IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 4 eyes of 4 patients, temporary intraocular pressure elevation in 7 eyes of 7 patients, and recurrent retinal detachment in 2 eyes of 2 patients.
The appropriate interval of secondary IOL implantation in open-globe injury after vitrectomy is important. Posterior chamber IOL implantation is performed in eyes with integrity of posterior capsule, and IOL sutured in the sulcus in eyes without posterior capsule support. It is safe and effective for secondary IOL implantation in open-globe injury after vitrectomy.
探讨玻璃体切除术后开放性眼球损伤二期人工晶状体（IOL）植入的时机和方法，并分析治疗效果及相关因素。
这是一项回顾性病例系列研究。分析了2007年至2012年在天津医科大学总医院接受玻璃体切除术后二期IOL植入的78例患者78只眼的临床资料。其中穿透伤27例27只眼，眼内异物（IFB）36例36只眼，眼球破裂4例4只眼，眼内炎11例11只眼。IFB中，磁性异物23例23只眼，玻璃异物6例6只眼，睫毛异物7例7只眼。玻璃体切除术中，31例31只眼用硅油填充，47例47只眼用C3F8填充。IOL植入方法包括后房型IOL植入32例32只眼，睫状沟固定IOL植入46例46只眼。IOL植入术前检查主要包括视力、裂隙灯显微镜、直接和间接检眼镜、视觉电生理、角膜内皮、B超、超声生物显微镜及眼压。4例4只眼行周边虹膜缝合，5例5只眼行虹膜裂伤缝合。玻璃体切除术前视力从光感至0.1。平均随访时间为15±3个月，范围为6至36个月。
IOL植入与玻璃体切除术的平均间隔时间为2.5±0.2个月，范围为1.5至6个月。玻璃体切除术后最佳矫正视力为0.1至1.0。未矫正视力范围为0.1至0.8，IOL植入术后最佳矫正视力为0.1至1.0。术后并发症主要包括4例4只眼轻度前房渗出，7例7只眼暂时性眼压升高，2例2只眼视网膜脱离复发。
玻璃体切除术后开放性眼球损伤二期IOL植入的合适间隔时间很重要。后囊完整的眼行后房型IOL植入，无后囊支持的眼将IOL缝合于睫状沟。玻璃体切除术后开放性眼球损伤二期IOL植入安全有效。
