囊袋拉钩联合Cionni改良囊袋张力环在马方综合征晶状体不全脱位手术中的应用
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摘要
目的探讨囊袋拉钩联合Cionni改良囊袋张力环(MCTR)在马方综合征晶状体不全脱位手术中应用的有效性和安全性。方法回顾性系列病例研究。马方综合征晶状体不全脱位患者28例(52眼),脱位范围为90°~120°2眼、120°~180°10眼、180°~270°36眼、270°以上4眼。术中使用2~4个囊袋拉钩稳定囊袋,植入MCTR并行巩膜缝合固定。分析术后视力、并发症、前囊口、人工晶状体(IOL)和MCTR的位置及眼压情况。结果随访6个月。除2眼环形撕囊失败,1眼撕囊口放射状裂开,2眼MCTR刺穿囊袋外,其余47眼均顺利完成晶状体吸除、MCTR及IOL植入。术中植入Cionni MCTR Morcher Type 2S型32眼、2L型1眼、2C型12眼、1G型2眼。术后术眼最佳矫正视力≥0.5者45眼,0.3~0.5者2眼,与术前矫正视力相比较,差异具有统计学意义(P<0.01)。术中、术后并发症包括前囊撕裂、MCTR刺穿囊袋、皮质残留、玻璃体脱出、前囊口收缩、囊袋-MCTR-IOL复合体偏中心和后囊膜混浊。结论囊袋拉钩可维持术中晶状体囊袋的稳定,而MCTR则保持术后IOL的长期稳定性。囊袋拉钩联合Cionni MCTR是马方综合征晶状体不全脱位手术较理想的选择。
Objective To investigate the effectiveness and safety of the capsular retractor combined with Cionni modified capsular tension ring( MCTR) during lens subluxation surgery in Marfan syndrome. Methods This retrospective case series study comprised 28 Marfan syndrome patients( 52 eyes) with lens subluxation. The lens dislocation ranged from 90° to 120°( 2 eyes),120° to 180°( 10 eyes),180° to 270°( 36 eyes),and above 270°( 4 eyes). Two to four capsular retractors were placed in the capsulorhexis to support the capsule and MCTR was inserted with scleral suture fixation. The outcome measures included postoperative visual acuity, complications, anterior capsulotomy,intraocular lens( IOL) and MCTR position,and intraocular pressure. Results The duration of follow-up was 6 months. In addition to the failure of continuous curvilinear capsulorhexis in 2 eyes,radial tear of capsulorhexis in1 eye,and the capsule pierced by MCTR in 2 eyes,the remaining 47 eyes had successfully undergone cataract aspiration,MCTR insertion and IOL implantation. The Morcher type of MCTR inserted was Type 2S in 32 eyes,Type 2L in 1 eye,Type 2C in 12 eyes,and Type 1G in 2 eyes. The best corrected visual acuity( BCVA),which was better than 0. 5 in 45 eyes and between 0. 3 and 0. 5 in 2 eyes after operation,improved significantly when compared with preoperative BCVA( P < 0. 01). The intra-and post-operative complications included anterior capsule tear,capsule stabbed by MCTR,cortical residual,vitreous prolapse,anterior capsular contraction,the decentration of capsule-MCTR-IOL complex,and posterior capsular opacification. Conclusions The capsular retractor can maintain the intraoperative stability of the capsule,while MCTR can keep the postoperative and long-term stability of IOLs. The capsular retractor combined with Cionni MCTR is an ideal choice for Marfan syndrome with lens subluxation.
Objective To investigate the effectiveness and safety of the capsular retractor combined with Cionni modified capsular tension ring( MCTR) during lens subluxation surgery in Marfan syndrome. Methods This retrospective case series study comprised 28 Marfan syndrome patients( 52 eyes) with lens subluxation. The lens dislocation ranged from 90° to 120°( 2 eyes),120° to 180°( 10 eyes),180° to 270°( 36 eyes),and above 270°( 4 eyes). Two to four capsular retractors were placed in the capsulorhexis to support the capsule and MCTR was inserted with scleral suture fixation. The outcome measures included postoperative visual acuity, complications, anterior capsulotomy,intraocular lens( IOL) and MCTR position,and intraocular pressure. Results The duration of follow-up was 6 months. In addition to the failure of continuous curvilinear capsulorhexis in 2 eyes,radial tear of capsulorhexis in1 eye,and the capsule pierced by MCTR in 2 eyes,the remaining 47 eyes had successfully undergone cataract aspiration,MCTR insertion and IOL implantation. The Morcher type of MCTR inserted was Type 2S in 32 eyes,Type 2L in 1 eye,Type 2C in 12 eyes,and Type 1G in 2 eyes. The best corrected visual acuity( BCVA),which was better than 0. 5 in 45 eyes and between 0. 3 and 0. 5 in 2 eyes after operation,improved significantly when compared with preoperative BCVA( P < 0. 01). The intra-and post-operative complications included anterior capsule tear,capsule stabbed by MCTR,cortical residual,vitreous prolapse,anterior capsular contraction,the decentration of capsule-MCTR-IOL complex,and posterior capsular opacification. Conclusions The capsular retractor can maintain the intraoperative stability of the capsule,while MCTR can keep the postoperative and long-term stability of IOLs. The capsular retractor combined with Cionni MCTR is an ideal choice for Marfan syndrome with lens subluxation.
引文
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[7]Drolsum L,Rand-Hendriksen S,Paus B,et al.Ocular findings in87 adults with Ghent-1 verified Marfan syndrome[J].Acta Ophthalmol,2015,93(1):46-53.
[8]Maumenee IH.The eye in the Marfan syndrome[J].Trans Am Ophthalmol Soc,1981,79:684-733.
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[11]蒋永祥,卢奕.晶状体不全脱位的手术治疗进展[J].中国眼耳鼻喉科杂志,2017,17(2):88-91.
[12]Hoffman RS,Snyder ME,Devgan U,et al.Management of the subluxated crystalline lens[J].J Cataract Refract Surg,2013,39(12):1904-1915.
[13]Chee S,Jap A.Management of traumatic severely subluxated cataracts[J].Am J Ophthalmol,2011,151(5):866-871.
[14]Jacob S,Agarwal A,Agarwal A,et al.Glued capsular hook:technique for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses[J].J Cataract Refract Surg,2014,40(12):1958-1965.
[15]陈佳惠,景清荷,蒋永祥.晶状体不全脱位手术方法研究进展[J].国际眼科纵览,2017,41(2):101-105.
[16]Hasanee K,Butler M,Ahmed II.Capsular tension rings and related devices:current concepts[J].J Curr Opin Ophthalmol,2006,17(1):31-41.
[17]Steinert RF.白内障手术学[M].刘奕志,译.3版.北京:人民军医出版社,2012:319-320.
[2]Fan F,Luo Y,Liu X,et al.Risk factors for postoperative complications in lensectomy-vitrectomy with or without intraocular lens placement in ectopia lentis associated with Marfan syndrome[J].Br J Ophthalmol,2014,98(10):1338-1342.
[3]Shah R,Weikert MP,Grannis C,et al.Long-term outcomes of irissutured posterior chamber intraocular lenses in children[J].Am J Ophthalmol,2016,161:44-49.
[4]Barbara R,Rufai SR,Tan N,et a1.Is an iris claw IOL a good option for correcting surgically induced aphakia in children?A review of the literature and illustrative case study[J].Eye(Lond),2016,30(9):1155-1159.
[5]Loeys BL,Dietz HC,Braverman AC,et al.The revised Ghent nosology for the Marfan syndrome[J].J Med Genet,2010,47(7):476-485.
[6]张怡,张帆,吐尔洪江·麦麦提,等.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[J].国际眼科杂志,2014,14(9):1627-1629.
[7]Drolsum L,Rand-Hendriksen S,Paus B,et al.Ocular findings in87 adults with Ghent-1 verified Marfan syndrome[J].Acta Ophthalmol,2015,93(1):46-53.
[8]Maumenee IH.The eye in the Marfan syndrome[J].Trans Am Ophthalmol Soc,1981,79:684-733.
[9]Chandra A,Ekwalla V,Child A,et al.Prevalence of ectopia lentis and retinal detachment in Marfan syndrome[J].Acta Ophthalmol,2014,92(1):e82-e83.
[10]李凤鸣,谢立信.中华眼科学[M].3版.北京:人民卫生出版社,2014:2371-2372.
[11]蒋永祥,卢奕.晶状体不全脱位的手术治疗进展[J].中国眼耳鼻喉科杂志,2017,17(2):88-91.
[12]Hoffman RS,Snyder ME,Devgan U,et al.Management of the subluxated crystalline lens[J].J Cataract Refract Surg,2013,39(12):1904-1915.
[13]Chee S,Jap A.Management of traumatic severely subluxated cataracts[J].Am J Ophthalmol,2011,151(5):866-871.
[14]Jacob S,Agarwal A,Agarwal A,et al.Glued capsular hook:technique for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses[J].J Cataract Refract Surg,2014,40(12):1958-1965.
[15]陈佳惠,景清荷,蒋永祥.晶状体不全脱位手术方法研究进展[J].国际眼科纵览,2017,41(2):101-105.
[16]Hasanee K,Butler M,Ahmed II.Capsular tension rings and related devices:current concepts[J].J Curr Opin Ophthalmol,2006,17(1):31-41.
[17]Steinert RF.白内障手术学[M].刘奕志,译.3版.北京:人民军医出版社,2012:319-320.