Mittra R A, Connor T B, Han D P, Koenig S B, Mieler W F, Pulido J S
Eye Institute, Medical College of Wisconsin, Milwaukee, USA.
Ophthalmology. 1998 Jun;105(6):1011-4. doi: 10.1016/S0161-6420(98)96001-8.
There are many alternatives available to the vitreoretinal surgeon in the management of posteriorly dislocated intraocular lenses (IOL). The lens may be repositioned in the ciliary sulcus if there is adequate capsular support, but if this support is absent, it must either be sutured in place (to the sclera or iris) or exchanged for an anterior chamber (AC) IOL. Scleral-sutured IOLs can be associated with hemorrhage, cystoid macular edema, retinal detachment, and endophthalmitis (through the suture tract), and use sutures that must last for the lifetime of the patient. Anterior chamber IOLs (ACIOLs) are easier to implant but require a limbal incision for insertion. The authors sought to determine the safety and efficacy of combining removal of posteriorly dislocated IOLs with ACIOL placement.
A retrospective chart review, in which all cases of dislocated IOLs managed at the authors' institution over the last 5 years were reviewed. Patient characteristics, pre-existing ocular conditions, preoperative visual acuity (VA), intraocular pressure (IOP), type of lens dislocated, operation performed, postoperative VA and IOP, and length of follow-up were recorded.
A total of nine cases were identified. Seven of these underwent primary posterior chamber (PC) IOL removal with ACIOL implantation. One had an ACIOL placed after a sulcus-sutured PCIOL dislocated, and one had enough capsular support for placement of a PCIOL after removal of a plate haptic silicone lens. Of the seven primary ACIOL cases, the best-corrected VA improved in five cases, was unchanged in one (remained 20/20), and declined in another. The final postoperative VA (mean follow-up, 12 months) was 20/30 or better in five patients, and was limited by age-related macular degeneration and epiretinal membrane in the other two. A hyphema occurred in two patients and cleared in both without visual compromise. There was no evidence of corneal compromise or exacerbation of glaucoma in any of the patients.
Given that the results and complication rates in this small series appear to be similar to those reported for sulcus-suture techniques, implantation of an ACIOL after removal of a posteriorly dislocated IOL appears to be a viable alternative to suture fixation in the absence of capsular support.
在处理后脱位的人工晶状体（IOL）时，玻璃体视网膜外科医生有多种选择。如果有足够的囊膜支撑，可将晶状体重新定位到睫状沟，但如果缺乏这种支撑，则必须将其缝合到位（缝合至巩膜或虹膜）或更换为前房型（AC）IOL。巩膜缝合IOL可能会导致出血、黄斑囊样水肿、视网膜脱离和眼内炎（通过缝线通道），且使用的缝线必须维持患者一生。前房型IOL（ACIOL）植入更容易，但需要在角膜缘做切口进行插入。作者试图确定将后脱位IOL取出与ACIOL植入相结合的安全性和有效性。
一项回顾性病历审查，回顾了作者所在机构过去5年中所有处理的IOL脱位病例。记录患者特征、既往眼部情况、术前视力（VA）、眼压（IOP）、脱位晶状体类型、所进行的手术、术后VA和IOP以及随访时间。
共确定9例。其中7例接受了初次后房型（PC）IOL取出并植入ACIOL。1例在沟内缝合的PCIOL脱位后植入了ACIOL，1例在取出板襻硅胶晶状体后有足够的囊膜支撑以植入PCIOL。在7例初次植入ACIOL的病例中，5例最佳矫正视力提高，1例不变（仍为20/20），另1例下降。最终术后视力（平均随访12个月），5例患者为20/30或更好，另外2例受年龄相关性黄斑变性和视网膜前膜限制。2例患者出现前房积血，均未造成视力损害而自行吸收。所有患者均无角膜损害或青光眼加重的证据。
鉴于这个小系列的结果和并发症发生率似乎与沟内缝合技术报告的相似，在缺乏囊膜支撑的情况下，取出后脱位IOL后植入ACIOL似乎是缝线固定的一个可行替代方法。
