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[摘要]
目的：评估25G+玻璃体切除联合经玻璃体腔巩膜缝线固定治疗高度近视患者Bigbag人工晶状体囊袋复合物脱位的临床效果。
方法：回顾性分析2016-07/2019-10武汉汉阳艾格眼科医院收治的高度近视患者Bigbag人工晶状体囊袋复合物脱位患者13例15眼的临床资料。所有患者均采用25G+玻璃体切除术，清理包绕人工晶状体囊袋复合物的玻璃体，玻璃体腔注入重水，使人工晶状体上浮至瞳孔区，经玻璃体腔将人工晶状体悬吊固定于巩膜上。其中1例1眼合并黄斑裂孔行内界膜剥离联合玻璃体腔注气，1例1眼合并视网膜裂孔予以视网膜激光光凝。
结果：术后1wk最佳矫正视力(LogMAR)为1.03±0.29，较术前的1.31±0.33显著改善(t=4.126，P=0.017)； 术前平均眼压(17.45±6.81mmHg)较术后1wk(16.75±6.71mmHg)无差异(t=1.635，P=0.360)； 角膜内皮细胞计数2 345.92±399.59cell/mm2较术前2 388.93±405.04cell/mm2无明显变化(t=2.323，P=0.279)； 随访期间所有患者角膜透明，人工晶状体位置正，无脉络膜脱离、视网膜脱离、出血、继发性青光眼并发症发生。
结论：高度近视患者Bigbag人工晶状体囊袋混合物脱位采用经玻璃体腔巩膜缝线固定安全有效，避免了人工晶状体囊袋复合物取出再植入悬吊人工晶状体的风险。
[Key word]
[Abstract]
AIM: To evaluate the efficacy of 25G
+vitrectomy combined with fixation by sclera suture through vitreous cavity in the treatment of Bigbag IOL-bag complex dislocation of high myopia.
METHODS: Totally 13 patients(15 eyes)of high myopia with Bigbag IOL-bag complex dislocation enrolled in this respective study. All cases underwent 25G+ vitrectomy. The vitreous body wrapped around the complex was cleaned and the heavy water was injected into the vitreous cavity to make the IOL float to the pupil area. The IOL was suspended and fixed on the sclera through the vitreous cavity. One case(1 eye)with macular hole was treated with inner limiting membrane peeling combined with gas injection, and laser photocoagulation was performed on 1 case(1 eye)with retinal hole.
RESULTS: The postoperative intraocular pressure(IOP)(16.75±6.71mmHg)was similar to the preoperative IOP(17.45±6.81mmHg)within normal limits(t=1.635, P=0.360), and best corrected visual acuity(BCVA, LogMAR)at 1wk postoperatively were ameliorated from 1.31±0.33 to 1.03±0.29(t=4.126, P=0.017). No significant difference was noted between preoperative(2388.93±405.04cell/mm2)and postoperative(2345.92±399.59cell/mm2)counting of corneal endothelial cell(t=2.323, P=0.279). Corneal transparency and position of IOL kept normal and no complications such as choroid detachment, retinal detachment, bleeding or secondary glaucoma was recorded in the follow-up period.
CONCLUSION: 25G vitrectomy combined with fixation by sclera suture through vitreous cavity contributes to the anatomical repair and visual function recovery of patients of high myopia with Bigbag IOL-bag complex dislocation.
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