改良囊袋张力环联合囊袋内人工晶状体植入治疗马方综合征晶状体不全脱位术后人工晶状体脱位的临床特征及手术治疗
Clinical characteristics and surgical treatment of postoperative intraocular lens dislocation following modified capsular tension ring and intraocular lens implantation for ectopia lentis in Marfan syndrome
陈泽旭 1贾婉楠 1王亚镭 1申鑫 1陈心姚 1蒋永祥1
作者信息
- 1. 复旦大学附属眼耳鼻喉科医院眼科 上海 200031
- 折叠
摘要
目的 观察接受改良囊袋张力环(MCTR)联合囊袋内人工晶状体(IOL)植入治疗的马方综合征(MFS)晶状体不全脱位患者术后IOL脱位的发生率,并总结接受IOL复位或取出术MFS患者的临床特征.方法 通过随访观察 2015 年 1 月—2020 年 6 月于我院同一手术医师行MCTR植入术且术后随访 3 年以上的MFS患者术后IOL脱位情况,计算其IOL脱位发生率.通过回顾分析我院同期就诊的MFS合并IOL脱位患者的临床资料,分析其临床特征和手术选择.结果 本研究共纳入同一手术医师行MCTR植入术患者 115 例(192 眼),大部分患者为儿童(80.21%,154/192),中位随访时间 4 年(四分位范围:3.50,4.67).随访期间共出现MCTR-IOL复合体脱位 3 例(3 眼),脱位发生率为 1.56%(3/192),其中 2 例为不全脱位、1 例为全脱位.3 例患者均为成人,IOL脱位发生时间为术后 2～3 年,均无明显诱因,直接原因均为缝线断裂.同期在我院接受IOL复位或取出术的MFS患者共 16 例.IOL脱位最常见的直接原因是缝线断裂(62.50%,10/16)、其次是缝线或可植入式囊袋拉钩在巩膜层间出现滑动松脱(18.75%,3/16).对于出现不全脱位的CTR或MCTR患者,通过缝线再次固定张力环或植入囊袋拉钩可实现IOL复位;MCTR脱位进入玻璃体腔的患者接受了MCTR取出和经巩膜后房型IOL缝线固定术;对于其他手术方式的IOL脱位患者,多数患者实现了脱位IOL复位术(54.55%,7/13),少数患者进行了IOL置换术(30.77%,4/13),2 例IOL取出后未植入IOL.结论 MCTR植入术是治疗MFS合并晶状体不全脱位的一种安全、有效的手术方式,IOL脱位是其罕见并发症.MFS患者术后定期随访十分必要,甚至需要终生随访,早期干预IOL脱位可以取得较好的疗效.
Abstract
Objective To report the incidence of intraocular lens(IOL)dislocation after modified capsular tension ring(MCTR)and IOL implantation in patients with Marfan syndrome(MFS)and ectopia lentis,and to report the clinical characteristics of MFS patients who underwent IOL repositioning or extraction in our hospital.Methods MFS patients who had undergone MCTR implantation by the same surgeon at our hospital from January 2015 to June 2020 were included.They were followed up for more than 3 years postoperatively to analyze the incidence of IOL dislocation.Patients with MFS and IOL dislocation who were treated at our hospital during the same period were retrospectively reviewed to analyze their clinical characteristics and surgical options.Results A total of 115 patients(192 eyes)who had undergone MCTR implantation by the same surgeon were included in this study,with the majority being children(80.21%,154/192).The median follow-up time was 4 years(IQR:3.50,4.67).During the follow-up period,there were 3 cases of MCTR-IOL complex dislocation,with 2 cases of subluxation and 1 case of total dislocation,resulting in an incidence rate of 1.56%(3/192).All of them were adults,and the occurrence of IOL dislocation was about 2 to 3 years postoperatively,with no obvious precipitating factors,and the direct cause was suture breakage.During the same period,a total of 16 MFS patients underwent IOL repositioning or extraction in our center.The most common direct cause of IOL dislocation was suture breakage(62.50%,10/16),followed by suture or intraocular bag hook slipping between the scleral stroma(18.75%,3/16).For patients with subluxation of CTR or MCTR,re-fixation of the tension ring with sutures or insertion of intraocular bag hooks could achieve IOL repositioning;patients with MCTR dislocation into the vitreous body underwent MCTR removal and scleral-fixated IOL implantation;for other patients previously receiving other IOL implantation methods,the majority underwent IOL reposition(54.55%,7/13),a minority underwent IOL exchange(30.77%,4/13),and 2 cases underwent IOL extraction without replacement.Conclusion MCTR implantation is a safe and effective surgical method for treating ectopia lentis in MFS patients,with IOL dislocation being a rare complication.Regular follow-up and lifelong monitoring are essential for MFS patients postoperatively,and early intervention for IOL dislocation can achieve good therapeutic effects.
关键词
马方综合征/晶状体不全脱位/人工晶状体脱位/改良囊袋张力环Key words
Marfan syndrome/Ectopia lentis/Intraocular lens dislocation/Modified capsular tension ring引用本文复制引用
出版年
2024
NETL
NSTL
万方数据