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脱位人工晶状体重新固定与置换的手术结果:一项回顾性队列研究

Surgical Outcome of Refixation versus Exchange of Dislocated Intraocular Lens: A Retrospective Cohort Study.

作者信息

Shin Young In, Park Un Chul

机构信息

Department of Ophthalmology, Seoul National University College of Medicine, Seoul 03080, Korea.

Retinal Degeneration Research Laboratory, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Korea.

出版信息

J Clin Med. 2020 Nov 28;9(12):3868. doi: 10.3390/jcm9123868.

Abstract

We compared the surgical outcomes and complications of refixation vs. exchange of dislocated intraocular lenses (IOLs) in patients who underwent transscleral suture fixation combined with pars plana vitrectomy for the treatment of IOL dislocation. A total of 83 eyes ( = 83 patients) with postoperative follow-up of ≥6 months were evaluated: 40 received refixation of dislocated IOL (refixation group) while 43 received IOL exchange (exchange group) treatment. Treatment outcomes, including best-corrected visual acuity (BCVA), spherical equivalent, corneal cylinder, intraocular pressure (IOP), central macular thickness (CMT), and corneal endothelial cell density (ECD), and postoperative complications were retrospectively reviewed. BCVA improvement at 6 months after surgery was comparable between the groups. Postoperative decrease in corneal ECD was significantly greater in the exchange group than in the refixation group, but no significant differences were found in spherical equivalent, corneal cylinder, IOP, or CMT changes. The exchange group experienced significantly more frequent postoperative vitreoretinal complications, such as retinal detachment, choroidal effusion, cystoid macular edema, and secondary epiretinal membrane, than the refixation group. Without any reason to extract the dislocated IOL, reuse of the dislocated IOL would be a better surgical option for transscleral suture fixation to protect corneal endothelial cells and prevent postoperative vitreoretinal complications.

摘要

我们比较了在接受经巩膜缝线固定联合玻璃体切除术治疗人工晶状体(IOL)脱位的患者中,脱位人工晶状体重新固定与置换的手术结果及并发症。共评估了83只眼(83例患者),术后随访时间≥6个月:40只眼接受脱位人工晶状体重新固定(重新固定组),43只眼接受人工晶状体置换(置换组)治疗。回顾性分析治疗结果,包括最佳矫正视力(BCVA)、等效球镜度、角膜散光、眼压(IOP)、中心黄斑厚度(CMT)和角膜内皮细胞密度(ECD),以及术后并发症。两组术后6个月时BCVA的改善情况相当。置换组术后角膜ECD的下降明显大于重新固定组,但等效球镜度、角膜散光、眼压或CMT变化方面未发现显著差异。置换组术后玻璃体视网膜并发症,如视网膜脱离、脉络膜渗漏、黄斑囊样水肿和继发性视网膜前膜,比重新固定组更频繁。在没有任何理由取出脱位人工晶状体的情况下,重新使用脱位人工晶状体对于经巩膜缝线固定来说是更好的手术选择,可保护角膜内皮细胞并预防术后玻璃体视网膜并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d1d/7760674/93f8e3c5893a/jcm-09-03868-g001.jpg

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