Obeng Francis Kwasi, Vig Vipan Kumar, Singh Preetam, Singh Rajbir, Dhawan Bodhraj, Sahajpal Nikhil
Long Term Vitreoretinal Fellow, Department of Vitreoretinal, Sardar Bahadur Dr. Sohan Singh Eye Hospital, Amritsar, Punjab, India.
Consultant Vitreoretinal Surgeon, Department of Vitreoretinal, Member Vitreoretinal Society of India, Sardar Bahadur Dr. Sohan Singh Eye Hospital, Amritsar, Punjab, India.
J Clin Diagn Res. 2017 Mar;11(3):NC09-NC13. doi: 10.7860/JCDR/2017/20989.9533. Epub 2017 Mar 1.
The best method of aphakia correction is in the bag implantation of Posterior Chamber Intraocular Lens (PCIOL). When this ideal procedure is not possible due to lack of integrity of posterior capsule or zonules, the other alternatives are broadly categorized into two: extraocular and intraocular. Whereas, the former includes contact lenses and aphakic glasses, the latter ones are further divided into anterior and posterior chamber methods. Anterior Chamber Intraocular Lenses (ACIOL) can be with or without iris claw. At the posterior chamber, fixation of the lenses can be with glue or sutures. When there is combined Pars Plana Vitrectomy (PPV) and lensectomy or if the indication of PPV is dropped nucleus or intraocular lens, a modality of aphakia correction should be devised. Posterior Chamber Scleral Fixation of Intraocular Lenses (PCSFIOL) with sutures is a preferred method because of its low complication profile. However, data on correction of aphakia after combined PPV and lensectomy is limited. To fill in this gap in knowledge, we evaluated the secondary PCSFIOL in aphakic eyes after previous PPV and lensectomy.
To assess the outcome and complication profile of a large series of patients who underwent secondary PCSFIOL implantation with sutures after combined PPV and lensectomy.
Records of all patients who had undergone secondary PCSFIOL implantation with sutures after combined PPV and lensectomy from 2010 to 2014 were reviewed retrospectively for visual outcomes and complications. Patients' demographic data, indication for PPV, best corrected preoperative and postoperative visual acuities, complications of surgery, and indications of PCSFIOL and length of follow up were collected and analyzed.
A total of 148 eyes of 148 patients (127 males and 21 females) were identified. Mean age at surgery was 32.5±8 years (range 2.5-73 years) with a mean follow up 23±14 months (range 3-114 months). A total of 95.27%, 2.70% and 2.02% of patients had improvement, maintenance and worsening of their final postoperative visual acuities respectively. A total of 32 (21.62%) of 148 eyes had postoperative complications from PCSFIOL with Epiretinal Membrane (ERM) formation being the most common. They all required one form of management or the other. Suture breakage leading to PCSFIOL subluxation or dislocation occurred in four eyes (2.70%).
PCSFIOL with sutures is a preferred method in the management of post-vitrectomised aphakic eyes when the capsular or zonular support is not adequate for in the bag implantation of posterior chamber intraocular lenses.
矫正无晶状体眼的最佳方法是后房型人工晶状体（PCIOL）囊袋内植入。当由于后囊膜或悬韧带完整性缺失而无法进行这一理想手术时，其他替代方法大致可分为两类：眼外法和眼内法。其中，前者包括隐形眼镜和无晶状体眼镜，后者又进一步分为前房法和后房法。前房型人工晶状体（ACIOL）可带或不带虹膜爪。在后房，晶状体固定可采用胶水或缝线。当合并玻璃体切割术（PPV）和晶状体切除术，或者PPV的适应证是晶状体核下沉或人工晶状体时，应设计一种无晶状体眼矫正方式。缝线固定的后房型人工晶状体巩膜固定术（PCSFIOL）因其低并发症发生率而成为首选方法。然而，关于PPV和晶状体切除术后无晶状体眼矫正的数据有限。为填补这一知识空白，我们评估了既往接受PPV和晶状体切除术后无晶状体眼中二期PCSFIOL的情况。
评估一大组在PPV和晶状体切除术后接受二期缝线固定PCSFIOL植入术患者的手术效果和并发症情况。
回顾性分析2010年至2014年所有在PPV和晶状体切除术后接受二期缝线固定PCSFIOL植入术患者的记录，以了解其视力结果和并发症情况。收集并分析患者的人口统计学数据、PPV的适应证、术前最佳矫正视力和术后视力、手术并发症、PCSFIOL的适应证以及随访时间。
共纳入148例患者的148只眼（男性127例，女性21例）。手术时的平均年龄为32.5±8岁（范围2.5 - 73岁），平均随访时间为23±14个月（范围3 - 114个月）。术后最终视力改善、维持和恶化的患者分别占95.27%、2.70%和2.02%。148只眼中共有32只眼（21.62%）发生了PCSFIOL术后并发症，其中视网膜前膜（ERM）形成最为常见。所有这些患者都需要一种或另一种形式的治疗。4只眼（2.70%）发生缝线断裂，导致PCSFIOL半脱位或脱位。
当囊膜或悬韧带支撑不足以进行后房型人工晶状体囊袋内植入时，缝线固定的PCSFIOL是治疗玻璃体切除术后无晶状体眼的首选方法。
