改良YAMANE式巩膜层间无缝线后房型人工晶状体固定术的疗效观察

Outcomes of the sutureless-intrascleral fixation of posterior chamber intraocular lens implantation using modified Yamane's technique

摘要:

目的：观察YAMANE式巩膜层间无缝线后房型人工晶状体固定术的术后效果、安全性及并发症。

方法：病例随访观察。选取2017-12/2018-09于华西医院眼科行YAMANE式巩膜层间无缝线后房型人工晶状体固定术患者5例，定期随访患者术后的裸眼视力(LogMAR)、最佳矫正视力(LogMAR)、等效球镜度数、眼压及人工晶状体位置等。

结果：患者3例术后矫正视力达0.0，术后等效球镜度数与目标屈光度相差为0.11～0.62D。术后3mo，1例患者裸眼视力达术前最佳矫正视力0.2，另1例患者术前存在角膜白斑及黄斑前膜牵拉水肿，矫正视力达到了术前验光最佳矫正效果。随访期间所有患者的人工晶状体袢凸缘及袢均保持在巩膜层间良好的位置，人工晶状体位置居中，未见明显偏心及倾斜。所有病例术后均未出现低眼压及其它并发症。

结论：YAMANE式巩膜层间无缝线后房型人工晶状体固定术切口小，无需制作巩膜瓣，不使用缝线及生物胶，手术时间短，人工晶状体位置居中且固定良好。此手术方式需要经过一定的学习曲线，掌握术中关键点操作，可以为患者带来快速、良好、稳定的术后效果，且术后并发症少。

Abstract:

AIM:To observe the post-operative outcomes, safety and complications of the sutureless-intrascleral fixation of posterior chamber intraocular lens(SF-PCIOL)by using the modified Yamane's technique.

METHODS:This study involved 5 patients who underwent SF-PCIOL with the modified Yamane's technique, from December 2017 to September 2018. The longest follow-up time was 12mo, and the primary outcomes included uncorrected visual acuity(UCVA, LogAMR)and bestcorrected visual acuity(BCVA, LogMAR), intraocular pressure and the location and stability of IOLs.

RESULTS: The BCVA of 3 patients were ranged from 0.0 to 0.1 by the time of following up 12mo postoperatively. The difference between the spherical equivalent refraction and the predicted spherical equivalent refraction was in a range of 0.11-0.62 diopters. In the other two cases, at 3mo after the surgery, the UCVA was 0.2 for one case, and the BCVA was the same as preoperative corrected visual acuity for another case, where the patient manifested corneal leucoma and macular edema prior to surgery. During the follow-up period, the flanges and the IOL haptics of all the recruited patients were maintained in an ideal position, the optics were located in center of the pupils, and no visible IOL decentration or tilt was observed. Neither hypotony nor other complications were discovered in all the cases.

CONCLUSION: For SF-PCIOL by using modified Yamane's technique, smaller incisions and shorter operation time are feasible, and the need for scleral flaps, sutures and fibrin glue is eliminated. The IOLs are well centered and fixed securely. A learning curve is necessary to master this surgery technique. As revealed by our initial observation, the surgery is capable of producing satisfactory and consistent postoperative outcomes for patients with fewer postoperative complications as long as the crucial points are fully understood.