囊袋张力环植入在剥脱综合征性青光眼术后白内障超乳术中的应用

Clinical application of capsular tension ring on cataract surgery in patients with pseudoexfoliation syndrome after trabeculectomy

摘要:

目的：探讨囊袋张力环(capsular tension ring，CTR)植入联合超声乳化人工晶状体(intraocular lens，IOL)植入术治疗剥脱综合征性青光眼术后白内障的安全性和有效性。

方法：回顾性分析2012-01/2013-06对连续性收治的剥脱综合征性青光眼小梁切除术后白内障10例10眼行超声乳化白内障摘除联合CTR及IOL植入术，Ⅱ级核1眼，Ⅲ级核4眼，Ⅳ级核5眼，其中Ⅳ级核合并虹膜、晶状体震颤1眼。分析术后裸眼及矫正视力、术中术后并发症、前囊撕囊口、IOL位置、术后眼压情况。随访3～14mo。

结果：所有患者均安全实施超声乳化白内障摘除、囊袋张力环及IOL植入术。其中改良悬吊双钩CTR 1眼，标准CTR 9眼。术眼矫正视力≥0.5者3眼，0.3～者2眼，≤0.1者5眼，所有患者均IOL无偏位，眼底均有不同程度的视神经萎缩。术前平均眼压16.78±2.48mmHg，术后3mo平均眼压16.01±2.33mmHg(t=1.9955，P<0.05)。术中术后最常见并发症为角膜水肿、瞳孔散不大、皮质残留、悬韧带松弛。

结论：剥脱综合征性青光眼小梁切除术后并发白内障，选择合适类型和合适时机的CTR植入可提高超声乳化手术安全性，防止IOL偏位，减少手术并发症的发生，早期手术并发症更少。

Abstract:

AIM:To investigate the safety and efficacy of capsular tension ring(CTR)insertion combined with phacoemulsification and intraocular lens(IOL)implantation in patient with pseudoexfoliation syndrome after anti-glaucoma surgery.

METHODS: A retrospective study was conducted of 10 eyes from 10 cataract patients with pseudoexfoliation syndrome following trabeculectomy surgery, and who underwent CTR insertion combined with phacoemulsification and IOL implantation between January, 2012 and June, 2013. All cases had nuclear cataracts(nuclear hardness Ⅱ 1 eye, nuclear hardness Ⅲ 4 eyes, nuclear hardness Ⅳ 5 eyes). One case with Ⅳ nuclear hardness cataract had iridodonesis and lens subluxation. Postoperative visual acuity, intra- and post-operative complications, anterior capsular opening, IOL position, and postoperative intraocular pressure(IOP)were assessed. Follow-ups ranged from 3 to 14mo. The t test was used to analyze the variables studied.

RESULTS: All patients had a successful CTR insertion combined with phacoemulsification and IOL implantation. A modified CTR insertion was performed in one case, the others underwent a standard CTR insertion. The best corrected visual acuity(BCVA)was ≥0.5 in 3 eyes and 0.3-<0.5 in 2 eyes. However, BCVA was ≤0.1 in 5 eyes. No decentration and dislocation of IOL was found during follow-up. Optic atrophy of different level could be found in all cases. The mean IOP was 16.78±2.48mmHg before surgery. And the average IOP is 16.01±2.33mmHg at 3mo postoperative(t=1.9955, P>0.05). The most common intrao- and post-operative complications were corneal edema, small pupil, residual cortex, spontaneous zonular dialysis.

CONCLUSION: Suitable CTR insertion in appropriate occasion may be beneficial to patients with pseudoexfoliation syndrome after trabeculectomy during cataract surgery. It prevents the IOL decentration and decrease the surgical complication. Less complication occurs at the early stage.