摘要
目的探讨白内障摘出术后角膜后弹力层脱离(descemet membrane detachment,DMD)的治疗。方法回顾性系列研究。选取2014年5月至2017年12月在汉口爱尔眼科医院诊治的白内障摘出术后DMD患者12例(12眼),经眼前节光学相干断层扫描(anterior segment optical coherence tomography,AS-OCT)确诊为DMD,其中轻度脱离5例、中度脱离3例、重度脱离4例。结果 12 968例行白内障摘出术患者中12例患者发生了DMD,其中8例为白内障超声乳化术后,4例为白内障囊外摘出术后,发生率分别是0.062%和3.101%。5例轻度、1例中度和1例重度DMD均经保守治疗痊愈,2例中度和1例重度DMD经前房注气术痊愈,而1例重度DMD经前房注气失败后改行角膜内皮移植术痊愈,1例重度DMD术中发现1/4悬韧带离断和中上方大范围后弹力层脱离,术毕行前房注气术,术后因体位原因气体进入后房和玻璃体腔继发闭角型青光眼,患者放弃治疗,逐渐发展为大泡性角膜病变。结论 DMD重在预防,一旦发生需要个性化治疗,综合考虑手术的必要性和风险、手术时机和方式的选择、自发性复位的可能性等。
Objective To develop a guideline for the management of descemet membrane detachment(DMD) after cataract surgery.Methods The retrospective series research of clinical cases were used for this study.From May 2014 to December 2017,12 patients of DMD who underwent cataract surgery were observed in clinic.All were confirmed by anterior segment optical coherence tomography(AS-OCT).Of 12 eyes,5 were mild DMD,3 were moderate,4 were severe.Results Of 12 968 cataract surgeries,DMD occurred in 12 patients,8(0.062%) of which underwent phacoemusification and 4(3.101%) of which underwent extracapsular cataract surgery.Five mild patients,1 moderate and 1 severe ones were resolved spontaneously with medical treatment.Two moderate and 1 severe patients were treated by intracameral air gas injection.Of 4 severe patients,1 was treated by descemet membrane endothelial keratoplasty after 3 ineffectual descemetopexy.One patient failed the descemetopexy with air tamponade because of inappropriate position which caused secondary glaucoma.Eventually,the female gave up to try another alternative method and corneal endothelium decompensation occurred.Conclusion The emphasis of DMD in the operation is prevention.Treatment decisions in DMD should consider a case-by-case evaluation of the detachment,need for surgery,the operation ways and risks,optimal time for intervention,probability of spontaneous resolution and so on.AS-OCT is not only a very useful tool for the diagnosis of DMD,but also provides basis for treatment.
作者
许荣
赵少贞
郑亦君
常晓可
XU Rong;ZHAO Shao-Zhen;ZHENG Yi-Jun;CHANG Xiao-Ke(Tianjin Medical University Eye Hospital,Tianjin Medical University Eye Institude,College of Optometry and Ophthalmology,Tianjin 300384,China;Hankou Aier Eye Hospital,Wuhan 430020,Hubei Province,China)
出处
《眼科新进展》
CAS
北大核心
2019年第7期662-665,共4页
Recent Advances in Ophthalmology
基金
武汉市临床医学科研项目(编号:WX17C33)~~
关键词
角膜后弹力层脱离
白内障手术
光学相干断层扫描
前房注气术
descemet membrane detachment
cataract surgery
segment optical coherence tomography
descemetopexy
