Department of Clinical Neuroscience, Division of Ophthalmology and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden.
Acta Ophthalmol. 2019 Sep;97(6):583-588. doi: 10.1111/aos.14059. Epub 2019 Feb 7.
To evaluate the efficacy and safety of iris suture fixation of out-of-the-bag dislocated three-piece intraocular lenses (IOL).
In a retrospective interventional consecutive case series, a chart review was performed in two groups of patients: fourteen patients with a dislocated out-of-the-bag three-piece IOL that underwent IOL fixation to the iris using the Siepser sliding knot technique (Iris group) and 18 patients with in-the-bag dislocation that underwent IOL exchange with a new scleral-sutured IOL (Exchange group). The Iris and Exchange groups were compared regarding surgical safety and efficacy. The median follow-up time was 13.5 months [interquartile range (IQR), 10-20] in the Iris group and 12.5 (IQR, 10-14) in the Exchange group.
The best corrected visual acuity (BCVA) improved significantly in both groups (p = 0.005 and 0.00006, respectively). No difference in final BCVA was seen between the groups. Significantly less surgically induced astigmatism (p = 0.03) and a lower number of postoperative visits (p = 0.0006) was noted in the Iris group. Considering the type of surgery, there were few complications in the present material.
In the study, suturing dislocated three-piece IOLs to the iris appeared to be an acceptable surgical management with less surgically induced corneal astigmatism and fewer postoperative visits than IOL exchange. A larger study with a longer follow-up time would be desirable to confirm the results.
评估虹膜缝线固定袋外脱位三片式人工晶状体（IOL）的疗效和安全性。
在回顾性、介入性、连续病例系列中，对两组患者进行了图表回顾：14 名脱位的三片式 IOL 袋外脱位患者（Iris 组）采用 Siepser 滑动结技术将 IOL 固定到虹膜上，18 名袋内脱位患者（Exchange 组）行新巩膜缝线固定 IOL 置换术。比较 Iris 和 Exchange 两组的手术安全性和疗效。Iris 组的中位随访时间为 13.5 个月（IQR，10-20），Exchange 组为 12.5 个月（IQR，10-14）。
两组最佳矫正视力（BCVA）均显著提高（p=0.005 和 0.00006）。两组间最终 BCVA 无差异。Iris 组术后角膜散光显著减少（p=0.03），术后就诊次数减少（p=0.0006）。考虑到手术类型，本研究中并发症较少。
在本研究中，将脱位的三片式 IOL 缝合到虹膜上似乎是一种可接受的手术治疗方法，与 IOL 置换相比，术后角膜散光更少，术后就诊次数更少。需要更大的研究和更长的随访时间来确认这些结果。
