双针导引无缝线巩膜层间固定二期人工晶体植入术的疗效分析

目的 探讨双针导引无缝线巩膜层间固定二期人工晶体（intraocular lens, IOL）植入术的应用价值。方法 回顾性分析于同济大学附属同济医院就诊的由不同原因所致、需行二期IOL植入术的21例（21只眼）的患者资料。采用双针导引无缝线巩膜层间固定二期IOL植入术，术中用两根29G针头分别在距角膜缘后2mm的相对位置做平行角膜缘、长3.6mm的巩膜层间隧道，三片式IOL折叠后注入，晶体襻与针头对接后即可在后者的导引下进入巩膜层间隧道，无需缝线即可完成IOL固定。观察患者手术前后的视力、角膜内皮细胞密度、术中术后并发症及IOL稳定性。结果 术后平均随访（5.5±1.8）个月。术前最佳矫正视力0.50±0.23，术后1个月裸眼视力0.52±0.20，两者间差异无统计学意义（t=1.51，P>0.05）。术后1个月最佳矫正视力为0.62±0.28，较术前升高（t=4.40，P<0.05）。术前角膜内皮细胞密度为（2301±164）个/mm2，术后3个月为（2267±182）个/mm2，两者间差异无统计学意义（t=0.43，P>0.05）。1例术后出现持续性眼压升高。术后无眼内炎、黄斑囊样水肿、视网膜脱离等严重并发症。术后随访期内OCT示各例术眼的IOL位置居中，未出现偏位或倾斜。结论 双针导引无缝线巩膜层间固定二期IOL植入术术式简易，不仅能避免缝线相关并发症，而且能稳定、有效地固定人工晶体，是一种值得推广的手术方法。
Objective To assess the application of sutureless intrascleral-fixed secondary intraocular lens (IOL) implantation with double-needle technique. Methods The clinical data of 21 patients (21 eyes) who needed secondary IOL implantations due to different reasons in our department were retrospectively analyzed. All cases underwent sutureless intrascleral-fixed secondary IOL implantation with double-needle technique. Two 3.6 mm long scleral tunnels parallelling to the limbus were created diametrically opposite in a distance of 2 mm from the limbus by two 29-gauge needles. A 3-piece IOL was then implanted into the anterior chamber. The haptics of the 3-piece IOL were sequentially guided into the bore of the 29-gauge needles and then fixated into scleral tunnels without sutures. Preoperative and postoperative visual acuity, corneal endothelial cell density, intraoperative and postoperative complications and the stability of the IOLs were observed. Results The mean follow-up time was 5.5±1.8 months. The preoperative best-corrected visual acuity (BCVA) was 0.50±0.23, and the uncorrected visual acuity (UCVA) at 1 month after surgery was 0.52±0.20 (t=1.51, P>0.05). The BCVA at 1 month after surgery was 0.52±0.20, which was improved compared with the preoperative one (t=4.40, P<0.05).The preoperative corneal endothelial cell density was (2301±164) cells/mm2 and that was (2267±182) cells/mm2 at 3 months after surgery (t=0.43, P>0.05). One case had durative intraocular hypertension postoperatively. There were no serious complications, such as endophthalmitis, cystoid macular edema, retinal detachment during the follow-up period. All the IOLs were fixed and centered well. Conclusion Sutureless intrascleral-fixed secondary IOL implantation with double-needle technique is a simple method which avoids suture-related complications and can achieve well positioned and stable IOL fixation