人工晶状体置换的原因及临床效果分析
Indications and clinical outcomes of intraocular lens exchange
胡方怡 1陈菁菁 1蒙娜 1李霞1
作者信息
- 1. 广西医科大学第一附属医院眼科 南宁 530021
- 折叠
摘要
目的 分析近 5 年接受人工晶状体(IOL)置换术的原因及其临床效果.方法 回顾性病例系列研究.收集 2019 年 1 月—2023 年 12 月在广西医科大学第一附属医院接受IOL置换术的患者的资料,包括患者基本信息、手术原因及间隔时间、手术前后的裸眼视力(UCVA)与最佳矫正视力(BCVA)以及术后并发症等.排除仅行IOL复位、背驮式IOL植入、取出IOL后未重新植入IOL的患者.结果 本研究共纳入 38例(47 眼),平均年龄(31.19±23.47)岁(4～80 岁),平均手术间隔时间为(8.4±7.0)年(13 d～28 年).手术原因包括:IOL移位或脱位16眼(34.0%),先天性白内障术后高度近视16眼(34.0%),IOL混浊5眼(10.6%),术后高散光 4 眼(8.5%),严重后发性白内障(PCO)和/或IOL损伤 3 眼(6.4%),多焦点IOL植入术后视觉质量不满意 1 眼(2.1%),IOL偏心 1 眼(2.1%),无法耐受色觉改变 1 眼(2.1%).术后高散光、多焦点IOL植入术后视觉质量不满意、IOL偏心、无法耐受色觉改变的手术间隔时间较短,均小于1 年,其余均为 5 年以上.IOL置换术临床效果良好,UCVA与BCVA均较术前显著提高.术前、术后的平均UCVA(logMAR)分别为1.32±0.65、0.66±0.42,差异有统计学意义(P＜0.001),术前、术后的平均BCVA(logMAR)分别为0.72±0.70、0.44±0.46,差异有统计学意义(P=0.001).除 1 例患者IOL置换术后第 2 天出现IOL移位需重新固定外,余无并发症发生.结论 IOL移位或脱位以及先天性白内障术后高度近视是IOL置换术的主要原因.术后高散光、多焦点IOL植入术后视觉质量不满意、IOL偏心、无法耐受色觉改变的手术间隔时间较短,是早期IOL置换原因,而IOL移位或脱位、先天性白内障术后高度近视、IOL混浊以及严重PCO和/或IOL损伤是远期置换的原因.IOL置换术具有一定的挑战性,但临床效果良好,并发症少.
Abstract
Objective To report the indications and clinical outcomes of intraocular lens(IOL)exchange surgery performed in a recent 5-year period.Methods In this retrospective case series study,patients who had undergone IOL exchange surgery from January 2019 to December 2023 at the First Affiliated Hospital of Guangxi Medical University were included.Patient demographics,indications,the interval time since the last operation,pre-and post-operative visual acuity(UCVA and BCVA),complications and etc.were recorded.Patients were excluded if they had undergone IOL repositioning or add-on IOL implantation,and those who had been left aphakic after IOL explantation.Results A total of 38 cases(47 eyes)were included,with an average age of 31.19±23.47 years(range 4 to 80 years),the mean interval time was 8.4±7.0 years(range 13 days to 28 years).Indications for surgery consisted of:IOL displacement/dislocation in 16 eyes(34.0%),high myopia following congenital cataract surgery in 16 eyes(34.0%),IOL opacification in 5 eyes(10.6%);postoperative high astigmatism in 4 eyes(8.5%),and severe PCO with or without IOL damage in 3 eyes(6.4%),IOL decentration in 1 eye(2.1%),patient dissatisfaction after multifocal IOL implantation in 1 eye(2.1%)and color intolerance in 1 eye(2.1%).The interval time of the postoperative high astigmatism,patient dissatisfaction after multifocal IOL implantation,IOL decentration and color intolerance were all less than 1 year,while others were over 5 years.The clinical outcomes of IOL exchange were good,both UCVA and BCVA were increased significantly.The mean UCVA(log MAR)pre-and post-operative was 1.32±0.65,0.66±0.42(P<0.001),and the mean BCVA(log MAR)pre-and post-operative was 0.72±0.70,0.44±0.46(P=0.001),respectively.Except for one case that had IOL displacement the day following IOL exchange and required IOL repositioning,no other complications were found.Conclusions IOL displacement/dislocation and high myopia following congenital cataract surgery were the primary reasons for IOL exchange.Postoperative high astigmatism,patient dissatisfaction after multifocal IOL implantation,IOL decentration and color intolerance had shorter operative interval time,which were early IOL exchange reasons.However,high myopia following congenital cataract surgery,IOL opacification,and severe PCO with or without IOL damage were related to long-term IOL exchange indications.IOL exchange is challenging,but the clinical outcomes were good,with few complications.
关键词
人工晶状体置换/人工晶状体移位或脱位/先天性白内障术后高度近视/术后高散光/临床效果Key words
Intraocular lens exchange/Intraocular lens displacement/dislocation/High myopia following congenital cataract surgery/Postoperative high astigmatism/Clinical outcomes引用本文复制引用
基金项目
国家自然科学基金(81360144)
广西自然科学基金(2017GXNSFAA198250)
出版年
2024
NETL
NSTL
万方数据