小切口可折叠四襻巩膜固定型人工晶状体植入术治疗马凡综合征晶状体半脱位
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摘要
目的评价小切口可折叠四襻巩膜固定型人工晶状体(intraocular lens,IOL)植入术治疗马凡综合征晶状体半脱位患者的临床效果及安全性。方法回顾性病例分析。12例(21眼)马凡综合征伴透明晶状体半脱位患者行晶状体摘出联合IOL巩膜固定植入联合前段玻璃体切割术。其中,IOL巩膜固定采用了小切口(2.85 mm)、可折叠、一片式、四襻固定型美国博士伦Akreos IOL。观察患者术前、术后的裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、眼压、术中及术后并发症。结果所有患者手术均顺利,术中、术后未见并发症。术后第1天2眼出现一过性眼压升高。术前UCVA为0.01～0.30 (0.13±0.11),BCVA为0.01～0.60 (0.29±0.17)。随访33～73(57.75±13.78)个月,术后最后一次随访,UCVA为0.10～0.80(0.41±0.22),BCVA为0.20～1.00(0.70±0.27),两者与术前相比,差异均有统计学意义(均为P<0.05)。IOL位置居中,瞳孔圆。结论小切口可折叠四襻固定型Akreos IOL悬吊术治疗马凡综合征晶状体半脱位有良好的临床效果及安全性。
Objective To evaluate the clinical results and safety of four-point scleral-sutured foldable intraocular lens(IOL) implantation through a small incision in the treatment of ectopialentis in patients with Marfan's syndrome.Methods All patients were analyzed retrospectively.Twenty-one eyes of 12 Marfan's syndrome patients with clear lens subluxation underwent lens aspiration combined with IOL scleral-fixation and anterior vitrectomy.A one-piece foldable Akreos IOL(Bausch & Lomb,USA) with 4 hollow haptics was sutured to the sclera through a 2.85 mm small incision.Uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),intraocular pressure,intraoperative and postoperative complications were evaluated.Results All eyes were successfully treated without intraoperative or postoperative complications.Transient ocular hypertension was observed in 2 eyes on the first postoperative day.Preoperative UCVA was 0.01-0.30(0.13±0.11) and BCVA was 0.01-0.60(0.29±0.17).The mean follow-up period was 33-73(57.75 ±13.78) months.At the last follow-up,the postoperative UCVA was 0.10-0.80(0.41±0.22) and the BCVA was 0.20-1.00(0.70±0.27),and UCVA and BCVA were improved significantly postoperatively(both P<0.05).Postoperative evaluation showed a well-centered IOL and round pupil in all patients.Conclusion Scleral fixation of a foldable Akreos IOL with 4 hollow haptics through a small incision is safe and effective in the treatment of ectopialentis in Marfan's syndrome patients.
Objective To evaluate the clinical results and safety of four-point scleral-sutured foldable intraocular lens(IOL) implantation through a small incision in the treatment of ectopialentis in patients with Marfan's syndrome.Methods All patients were analyzed retrospectively.Twenty-one eyes of 12 Marfan's syndrome patients with clear lens subluxation underwent lens aspiration combined with IOL scleral-fixation and anterior vitrectomy.A one-piece foldable Akreos IOL(Bausch & Lomb,USA) with 4 hollow haptics was sutured to the sclera through a 2.85 mm small incision.Uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),intraocular pressure,intraoperative and postoperative complications were evaluated.Results All eyes were successfully treated without intraoperative or postoperative complications.Transient ocular hypertension was observed in 2 eyes on the first postoperative day.Preoperative UCVA was 0.01-0.30(0.13±0.11) and BCVA was 0.01-0.60(0.29±0.17).The mean follow-up period was 33-73(57.75 ±13.78) months.At the last follow-up,the postoperative UCVA was 0.10-0.80(0.41±0.22) and the BCVA was 0.20-1.00(0.70±0.27),and UCVA and BCVA were improved significantly postoperatively(both P<0.05).Postoperative evaluation showed a well-centered IOL and round pupil in all patients.Conclusion Scleral fixation of a foldable Akreos IOL with 4 hollow haptics through a small incision is safe and effective in the treatment of ectopialentis in Marfan's syndrome patients.
引文
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[12] LUEBKE J,REINHARD T,AGOSTINI H,BOEHRINGER D,EBERWEIN P.Long-term follow-up after scleral lens fixation in patients with Marfan syndrome[J].BMC Ophthalmol,2017,17(1):235.
[13] FASS O N,HERMAN W K.Sutured intraocular lens placement in aphakic post-vitrectomy eyes viasmall-incision surgery[J].J Cataract Refract Surg,2009,35(9):1492-1497.
[14] FASS O N,HERMAN W K.Four-point suture scleral fixation of a hydrophilic acrylic IOL in aphakic eyes with insufficient capsule support[J].J Cataract Refract Surg,2010,36(6):991-996.
[15] LIU H T,JIANG Z X,TAO L M.New two-point scleral-fixation technique for foldable intraocular lenses with four hollow haptics[J].Int J Ophthalmol,2015,9(3):469-471.
[2] FAIVRE L,MASUREL-PAULET A,COLLOD-BéROUD G,CALLEWAERT B L,CHILD A H,STHENEUR C,et al.Clinical and molecular study of 320 children with Marfan syndrome and related type I fibrillinopathies in a series of 1009 probands with pathogenic FBN1 mutations[J].Pediatrics,2009,123(1):391-398.
[3] FUSAR-POLI P,KLERSY C,STRAMESI F,CALLEGARI A,ARBUSTINI E,POLITI P.Determinants of quality of life in Marfan syndrome[J].Psychosomatics,2008,49 (3):243-248.
[4] LALLY DR,MONSONEGO J.Images in clinical medicine.Ectopia lentis in Marfan’s syndrome[J].N Engl J Med,2014,371(19):e28.
[5] SRIDHAR J,CHANG J S.Marfan’s syndrome with ectopia lentis[J].N Engl J Med,2017,377(11):1076.
[6] DIETLEIN T S,JACOBI P C,KONEN W,KRIEGLSTEIN G K.Complications of endocapsular tension ring implantation in a child with Marfan’s syndrome[J].J Cataract Refract Surg,2000,26(6):937-940.
[7] KIM W S.Transscleral intraocular lens fixation with preservation of the anterior vitreous face in patients with marfan syndrome and ectopia lentis[J].Cornea,2010,29(1):S20-24.
[8] MIR S,WHEATLEY H M,HUSSELS I E,WHITTUM-HUDSON J A,TRABOULSI E I.A comparative histologic study of the fibrillin microfibrillar system in the lens capsule of normal subjects and subjects with Marfan syndrome[J].Invest Ophthalmol Vis Sci,1998,39(1):84-93.
[9] HOLT D G,YOUNG J,STAGG B,AMBATI B K.Anterior chamber intraocular lens,sutured posterior chamber intraocular lens,or glued intraocular lens:where do we stand[J]?Curr Opin Ophthalmol,2012,23(1):62-67.
[10] SUNDMACHER R,ALTHAUS C,WESTER R.Experience with transscleral fixation of posterior chamber lenses[J].Graefes Arch Clin Exp Ophthalmol,1991,229(6):512-516.
[11] STEM M S,TODORICH B,WOODWARD M A,HSU J,WOLFE J D.Scleral-fixated intraocular lenses:past and present[J].J Vitreoretin Dis,2017,1(2):144-152.
[12] LUEBKE J,REINHARD T,AGOSTINI H,BOEHRINGER D,EBERWEIN P.Long-term follow-up after scleral lens fixation in patients with Marfan syndrome[J].BMC Ophthalmol,2017,17(1):235.
[13] FASS O N,HERMAN W K.Sutured intraocular lens placement in aphakic post-vitrectomy eyes viasmall-incision surgery[J].J Cataract Refract Surg,2009,35(9):1492-1497.
[14] FASS O N,HERMAN W K.Four-point suture scleral fixation of a hydrophilic acrylic IOL in aphakic eyes with insufficient capsule support[J].J Cataract Refract Surg,2010,36(6):991-996.
[15] LIU H T,JIANG Z X,TAO L M.New two-point scleral-fixation technique for foldable intraocular lenses with four hollow haptics[J].Int J Ophthalmol,2015,9(3):469-471.