Yusef Yu N, Voronin G V, Yusef S N, Vvedenskiy A S, Shkolyarenko N Yu, Alkharki L, Shashorina S A, Sharnina T V
Research Institute of Eye Diseases, Moscow, Russia.
Vestn Oftalmol. 2020;136(4):105-109. doi: 10.17116/oftalma2020136041105.
Prevention of decentration and dislocation of the "capsular bag + intraocular lens" (IOL) complex in the late postoperative period is an actual problem of surgical treatment of patients with pronounced lens subluxation.
To conduct a comparative clinical study of positional stability of the "capsular bag + IOL" complex in the late postoperative period after application of a combined technique of capsular bag fixation in patients with subluxation of the lens.
Phacoemulsification (PE) with in-the-bag IOL implantation and postoperative observation was performed in 213 patients (234 eyes) with cataract and pronounced lens subluxation. The 1 group consisting of 138 patients (153 eyes) underwent capsular bag fixation of the combined technique with simultaneous use of 4 modified iris-retractors and one or two capsular tension rings (CTRs). The 2 group included 75 patients (81 eyes) who in the course of PE had their capsular bag fixed beyond the edge of capsulorhexis with only 4 modified iris-retractors. Preoperative state of the lens and the evaluation of the frequency and degree of decentration of the «capsular bag + IOL» complex in the postoperative period were performed using data acquired with ultrasound biomicroscopy (UBM).
Significant (more than 1 mm according to UBM) IOL's optic decentration was observed in the 1 group after applying the combined capsular bag fixation technique in 12 (7.8%) cases, and in the 2 group after isolated use of modified iris-retractors in 48 (59.3%) cases.
The use of the combined capsular bag fixation technique not only improves the conditions for carrying out PE with in-the-bag IOL implantation in patients with pronounced lens subluxation, but also contributes to a substantial (an average of 8 times) reduction in the incidence of significant decentration of the «capsular bag + IOL» complex in the late postoperative period.
预防“囊袋+人工晶状体”(IOL)复合体在术后晚期的偏心和脱位是晶状体半脱位患者手术治疗中的一个实际问题。
对晶状体半脱位患者应用囊袋固定联合技术后,“囊袋+IOL”复合体在术后晚期的位置稳定性进行比较临床研究。
对213例(234眼)患有白内障且晶状体明显半脱位的患者进行了超声乳化白内障吸除术(PE)及囊袋内人工晶状体植入术,并进行术后观察。第1组由138例(153眼)患者组成,采用联合技术进行囊袋固定,同时使用4个改良虹膜拉钩和1个或2个囊袋张力环(CTR)。第2组包括75例(81眼)患者,在PE过程中仅使用4个改良虹膜拉钩将囊袋固定在撕囊边缘之外。利用超声生物显微镜(UBM)获得的数据对晶状体的术前状态以及术后“囊袋+IOL”复合体偏心的频率和程度进行评估。
在第1组中,应用联合囊袋固定技术后,有12例(7.8%)观察到人工晶状体光学部明显偏心(根据UBM超过1mm);在第2组中,仅使用改良虹膜拉钩后,有48例(59.3%)观察到明显偏心。
联合囊袋固定技术的应用不仅改善了晶状体明显半脱位患者进行囊袋内人工晶状体植入的超声乳化白内障吸除术的条件,而且有助于在术后晚期将“囊袋+IOL”复合体明显偏心的发生率大幅降低(平均降低8倍)。