Kim Eric J, Berg James P, Weikert Mitchell P, Kong Lingkun, Hamill Marshall B, Koch Douglas D, Yen Kimberly G
Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
Am J Ophthalmol. 2014 Nov;158(5):899-904. doi: 10.1016/j.ajo.2014.08.002. Epub 2014 Aug 12.
To report the short-term outcomes and complications of implantation of scleral-fixated capsular tension rings and/or capsular tension segments with intraocular lenses (IOL) in pediatric patients with ectopia lentis.
Retrospective, observational case series.
Thirteen consecutive pediatric patients (19 eyes) underwent placement of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring between January 1, 2009 and March 30, 2013 by 3 anterior segment surgeons at a single academic center. The scleral fixation suture was 9-0 polypropylene in 16 eyes and CV-8 Gore-Tex (expanded polytetrafluoroethylene) in 3 eyes. Outcome measures included change in corrected distance visual acuity (CDVA) and complications.
The mean age was 10.2 years ± 4.8 (SD) and the median follow-up, 23.4 months. A Cionni modified capsular tension ring was implanted in 5 eyes and a capsular tension segment with an unsutured capsular tension ring was implanted in 12 eyes. In 2 eyes, capsular tension segment alone was placed. The mean CDVA at the final follow-up (0.10 ± 0.11 logMAR, 18 eyes) was significantly better than preoperatively (0.58 ± 0.26 logMAR, 15 eyes) (P < .001). The CDVA at the final follow-up was 20/40 or better in 18 eyes (94.7%). All IOLs were well centered. Posterior capsule opacification developed in 11 eyes (57.9%), 9 eyes (47.4%) required neodymium-yttrium-aluminum-garnet capsulotomy, and 3 eyes (15.8%) required pars plana vitrectomy and posterior capsulotomy. Other complications included broken suture (5.3%) (9-0 polypropylene at CTR eyelet, repaired with CV-8 Gore-Tex), conjunctival dehiscence (5.3%), suture exposure (5.3%) (trans-scleral 9-0 polypropylene), and vitreous strand at inferior paracentesis (5.3%).
Implantation of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring appears to be a safe and effective technique for visual rehabilitation in pediatric ectopia lentis.
报告巩膜固定型囊袋张力环和/或囊袋张力节段联合人工晶状体（IOL）植入术治疗小儿晶状体异位的短期疗效和并发症。
回顾性观察病例系列。
2009年1月1日至2013年3月30日，在单一学术中心，3位眼前段外科医生为13例连续的小儿患者（19只眼）植入了囊袋内IOL，其中5只眼植入了Cionni改良囊袋张力环，12只眼植入了带未缝合囊袋张力环的囊袋张力节段并联合传统囊袋张力环。16只眼的巩膜固定缝线为9-0聚丙烯缝线，3只眼为CV-8 Gore-Tex（膨体聚四氟乙烯）缝线。观察指标包括矫正远视力（CDVA）的变化和并发症。
平均年龄为10.2岁±4.8（标准差），中位随访时间为23.4个月。5只眼植入了Cionni改良囊袋张力环，12只眼植入了带未缝合囊袋张力环的囊袋张力节段。2只眼单独植入了囊袋张力节段。末次随访时18只眼的平均CDVA（0.10±0.11 logMAR）显著优于术前（0.58±0.26 logMAR，15只眼）（P<0.001）。末次随访时18只眼（94.7%）的CDVA为20/40或更好。所有人工晶状体均居中良好。11只眼（57.9%）发生了后囊膜混浊，9只眼（47.4%）需要钕钇铝石榴石激光后囊膜切开术，3只眼（15.8%）需要玻璃体切割术联合后囊膜切开术。其他并发症包括缝线断裂（5.3%）（在囊袋张力环小孔处的9-0聚丙烯缝线，用CV-8 Gore-Tex修复）、结膜裂开（5.3%）、缝线外露（5.3%）（经巩膜9-0聚丙烯缝线）和下方穿刺口处的玻璃体条索（5.3%）。
植入带Cionni改良囊袋张力环或囊袋张力节段并联合传统囊袋张力环的囊袋内人工晶状体似乎是小儿晶状体异位视觉康复的一种安全有效的技术。
