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[改良矢根技术行无缝线巩膜内人工晶状体固定术的疗效]

[Efficacy of sutureless intrascleral intraocular lens fixation with the modified Yamane technique].

作者信息

Chen Y Y, Zhou D, Li L, Li D J, He L, Yu J, Shi X Y

机构信息

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China.

出版信息

Zhonghua Yan Ke Za Zhi. 2024 Jun 11;60(6):503-510. doi: 10.3760/cma.j.cn112142-20240103-00008.

Abstract

To evaluate the efficacy of sutureless intrascleral intraocular lens (IOL) fixation with the modified Yamane technique. It was a retrospective case series study. Patients undergoing sutureless intrascleral IOL fixation with the modified Yamane technique were included at Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University from January 2022 to September 2023. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), recorded as the logarithm of the minimum angle of resolution (logMAR), were measured before surgery and at 1 day, 3 days, 1 week, 1 month, and 3 months postoperatively. Refractive error and intraocular pressure were also checked. Anterior segment examination with a slit lamp microscope, fundus examination, anterior segment and posterior segment optical coherence tomography were performed. Intraoperative and postoperative ocular complications were documented. A total of 53 patients (53 eyes) were included in this study, comprising 40 males and 13 females, with a median age of 60 (49, 68) years. Among them, the proportion of a history of trauma was 22.6% (12/53). There was 1 eye with intraoperative vitreous hemorrhage (1.9%). All eyes had no obvious hypotony, no obvious inflammation in the anterior chamber, and no pupillary abnormalities at 1 week after surgery. The mean follow-up time was (8.0±3.3) months (range, 3 to 16 months). There was no iris capture, re-dislocation, or haptic exposure of the IOL during the follow-up. The corneal endothelial cell density was (2 236±704) cells/mm preoperatively and (1 964±628) cells/mm at 1 month, with significant difference (<0.001). The UCVA (logMAR) was 1.53±0.75 preoperatively, 0.18±0.17 at 1 month, 0.15±0.14 at 3 months, and 0.14±0.13 at the final visit (<0.001). The UCVA (logMAR) at 1 month was significantly different from that at 3 months and the final visit (both <0.05). At 1 month, 50.9% (27/53) of the eyes had an UCVA (logMAR)≤0.1, and the rate was 56.6% (30/53) at 3 months. The BCVA (logMAR) was 0.25±0.21, 0.03±0.06, 0.02±0.06, and 0.02±0.06 before surgery, at postoperative1 month, 3 months, and the final visit, respectively (<0.001). The BCVA (logMAR) at 1 month was not significantly different from that at 3 months and the final visit (both >0.05). The rate of the eyes with a BCVA (logMAR)≤0 was 81.1% (43/53) at 1 month and 83.0% (44/53) at 3 months. The IOL tilt was (5.18±2.60)° at postoperative 1 month and (5.08±2.48)° at postoperative 3 months, without statistically significant difference (>0.05). The IOL decentration was (0.35±0.24) mm at postoperative 1 month and (0.32±0.24) mm at postoperative 3 months, without statistically significant difference (>0.05). Sutureless intrascleral IOL fixation with the modified Yamane technique is simpler and more minimally invasive to achieve a stable and centered IOL implantation with fewer complications and good visual prognosis.

摘要

评估改良矢根技术进行无缝线巩膜内人工晶状体(IOL)固定术的疗效。这是一项回顾性病例系列研究。2022年1月至2023年9月在北京同仁医院北京同仁眼科中心接受改良矢根技术无缝线巩膜内IOL固定术的患者纳入研究。术前及术后1天、3天、1周、1个月和3个月测量未矫正视力(UCVA)和最佳矫正视力(BCVA),以最小分辨角的对数(logMAR)记录。还检查屈光不正和眼压。使用裂隙灯显微镜进行眼前节检查、眼底检查、眼前节和后节光学相干断层扫描。记录术中及术后眼部并发症。本研究共纳入53例患者(53只眼),其中男性40例,女性13例,中位年龄60(49,68)岁。其中,有外伤史的比例为22.6%(12/53)。有1只眼术中发生玻璃体出血(1.9%)。术后1周时所有眼均无明显低眼压、无前房明显炎症及无瞳孔异常。平均随访时间为(8.0±3.3)个月(范围3至16个月)。随访期间未发生虹膜夹持、人工晶状体再脱位或襻暴露。术前角膜内皮细胞密度为(2 236±704)个/mm²,1个月时为(1 964±628)个/mm²,差异有统计学意义(<0.001)。术前UCVA(logMAR)为1.53±0.75,1个月时为0.18±0.17,3个月时为0.15±0.14,末次随访时为0.14±0.13(<0.001)。1个月时UCVA(logMAR)与3个月及末次随访时相比差异有统计学意义(均<0.05)。1个月时,50.9%(27/53)的眼UCVA(logMAR)≤0.1,3个月时该比例为56.6%(30/53)。术前、术后1个月、3个月及末次随访时BCVA(logMAR)分别为0.25±0.21、0.03±0.06、0.02±0.06和0.02±0.06(<0.001)。1个月时BCVA(logMAR)与3个月及末次随访时相比差异无统计学意义(均>0.05)。1个月时BCVA(logMAR)≤0的眼比例为81.1%(43/53),3个月时为83.0%(44/53)。术后1个月人工晶状体倾斜度为(5.18±2.60)°,术后3个月为(5.08±2.48)°,差异无统计学意义(>0.05)。术后1个月人工晶状体偏心度为(0.35±0.24)mm,术后3个月为(0.32±0.24)mm,差异无统计学意义(>0.05)。改良矢根技术无缝线巩膜内IOL固定术操作更简单、微创,可实现人工晶状体稳定居中植入,并发症少,视觉预后良好。

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