Mallick Pauline, Fung Adrian T
Department of Ophthalmology, Sydney Eye Hospital, Sydney, NSW, Australia.
Westmead and Central Clinical Schools, Specialty of Ophthalmology and Eye Health, The University of Sydney, Sydney, NSW, Australia.
Int Ophthalmol Clin. 2025 Jan 1;65(1):75-80. doi: 10.1097/IIO.0000000000000548. Epub 2024 Dec 23.
To report visual and refractive outcomes and intraoperative and postoperative complications after pars plana vitrectomy (PPV) with retropupillary implantation of an iris clip intraocular lens (IOL).
This is a retrospective case series of patients who underwent secondary retropupillary intraocular lens insertion combined with pars plana vitrectomy to treat aphakia secondary to a dislocated nucleus lens (group A); or IOL dislocation (group B). Patient demographics, preoperative visual and refractive outcomes, intraoperative factors, postoperative visual and refractive outcomes, and complications within the follow-up period ranging from 6 months up to 3 years postoperative, were recorded.
In total, 57 eyes of 50 patients were included with a follow-up range of 6 months to 3 years. The overall mean age was 77.0 years (range 28 to 99 years), with 26/50 (52%) of patients being male. There were 13/57 (22.8%) patients in group A and 44/57 (77.2%) patients in group B. The single most common identifiable cause for lens dislocation was pseudoexfoliation, which was seen in 13/57 (22.8%) of eyes. The mean improvement in visual acuity (baseline and final follow) was 0.72 logMAR (1.09 logMAR to 0.37 logMAR) in all patients, 1.12 logMAR (1.64 logMAR to 0.52 logMAR) in group A, and 0.60 logMAR (0.91 logMAR to 0.31 logMAR) in group B. In 46 eyes (80.7%), postoperative refractive errors were within ±1.00 dioptres (D) of the target refraction, with a mean difference of 0.36D from target refraction. Complications included corneal edema (35.1%), hyphema (26.3%), anterior chamber inflammation (26.3%), vitreous hemorrhage (14%), elevated intraocular pressure (IOP, 12.3%) and cystoid macular edema (CME, 5.3%). All these complications were managed with topical medical therapy and did not require further surgical intervention. One eye from group A was the only eye that developed retinal detachment (RD) or endophthalmitis. No patients had IOL dislocation in the postoperative follow-up period, which ranged from 6 months to 3 years.
Retropupillary implantation of an iris clip IOL with pars plana vitrectomy is an efficient, predictable, and stable surgical option for aphakic eyes without capsular support. Postoperative corneal edema, hyphema, and anterior chamber inflammation are common but usually resolve without the need for further surgical intervention.
报告经瞳孔后房型虹膜夹人工晶状体（IOL）植入联合玻璃体切割术（PPV）后的视力、屈光结果以及术中、术后并发症。
这是一项回顾性病例系列研究，纳入了因晶状体核脱位继发无晶状体眼（A组）或人工晶状体脱位（B组）而接受经瞳孔后房型人工晶状体植入联合玻璃体切割术的患者。记录患者的人口统计学资料、术前视力和屈光结果、术中因素、术后视力和屈光结果以及术后6个月至3年随访期内的并发症。
共纳入50例患者的57只眼，随访时间为6个月至3年。总体平均年龄为77.0岁（范围28至99岁），50例患者中有26例（52%）为男性。A组有13/57（22.8%）例患者，B组有44/57（77.2%）例患者。晶状体脱位最常见的单一可识别原因是假性剥脱，在57只眼中有13只眼（22.8%）出现。所有患者的平均视力改善（基线和最终随访）为0.72 logMAR（从1.09 logMAR提高到0.37 logMAR），A组为1.12 logMAR（从1.64 logMAR提高到0.52 logMAR），B组为0.60 logMAR（从0.91 logMAR提高到0.31 logMAR）。46只眼（80.7%）术后屈光不正与目标屈光度数相差±1.00屈光度（D）以内，与目标屈光度数的平均差值为0.36D。并发症包括角膜水肿（35.1%）、前房积血（26.3%）、前房炎症（26.3%）、玻璃体积血（14%）、眼压升高（IOP，12.3%）和黄斑囊样水肿（CME，5.3%）。所有这些并发症均通过局部药物治疗得到处理，无需进一步手术干预。A组的一只眼是唯一发生视网膜脱离（RD）或眼内炎的眼睛。在术后6个月至3年的随访期内，没有患者发生人工晶状体脱位。
经瞳孔后房型虹膜夹人工晶状体植入联合玻璃体切割术是无晶状体囊膜支持眼的一种有效、可预测且稳定的手术选择。术后角膜水肿、前房积血和前房炎症很常见，但通常无需进一步手术干预即可消退。
