摘要
目的:分析亲水性丙烯酸酯人工晶状体(IOL)植入术后远期混浊的原因与IOL置换术的预后效果。方法:回顾性系列病例研究。收集2019年1月至2020年6月山东第一医科大学附属青岛眼科医院诊断为超声乳化白内障吸除联合IOL植入术后远期亲水性丙烯酸酯IOL混浊的患者15例(15只眼)。分析患者临床资料;选取其中2片混浊IOL使用共聚焦显微镜和扫描电镜观察其表面沉淀物的位置和形态,利用能谱分析检测沉淀物中的元素成分;分析行IOL置换术患者术中、术后并发症;采用配对 t检验比较IOL置换术前后最佳矫正视力(BCVA)。 结果:15例患者发现IOL混浊与首次IOL植入间隔时间为(27.3±5.9)个月,均为单眼IOL混浊,其中9例患有高血压病;在山东第一医科大学附属青岛眼科医院行白内障摘除手术的10例患者中4例糖化血红蛋白A1c明显超出正常值。混浊IOL在共焦显微镜下可见其表面有大量珊瑚状颗粒物沉淀;扫描电镜观察可见颗粒物沉淀结晶以多形态聚集,上下交错,富有层次感;能谱分析证实IOL附着的沉积物中含钙、磷元素。13例(13只眼)行IOL置换术,术中4例发生晶状体后囊膜破裂,3例新IOL植入睫状沟内,1例悬韧带断裂;裸眼BCVA(最小分辨角对数视力)IOL置换术前为1.03±0.64,IOL置换术后为0.39±0.21,差异有统计学意义( P<0.05)。 结论:亲水性丙烯酸酯IOL植入术后远期混浊为表面钙磷化合物沉积所致,IOL置换术能安全有效改善患者的预后视力。
Objective To analyze the cause of late postoperative opacification of hydrophilic acrylic intraocular lenses(IOLs)and the effect of IOL replacement surgery.Methods This retrospective case series study comprised 15 eyes of 15 patients who were diagnosed as late postoperative opacification of hydrophilic acrylic IOLs from January 2019 to June 2020 at Qingdao Eye Hospital of Shandong First Medical University.The clinical data of patients were reviewed,and two IOLs were examined by scanning electron microscopy and energy dispersive X-ray spectroscopy.The intraoperative and postoperative complications of IOL replacement surgery were evaluated,and best corrected visual acuity was compared before and after surgery.Preoperative and postoperative data were compared using the paired t test.Results The interval between the first IOL implantation and the detection of IOL opacification in 15 patients was(27.3±5.9)months.All the 15 patients had unilateral IOL opacification,and 9 patients had hypertension.Glycosylated hemoglobin A1c was significantly higher than the normal value in 4 of the 10 patients who underwent cataract surgery at our hospital.Confocal microscopy disclosed coralliform deposits on the superficial IOL optic.Scanning electron microscopy and energy dispersive X-ray spectroscopy showed the presence of calcium and phosphorus crystals in the opacification region of IOLs.Visual acuity in all 13 eyes receiving IOL exchange was significantly improved from 1.03±0.64(logarithm of the minimum angle of resolution)to 0.39±0.21(P<0.05).Posterior capsule rupture(4 eyes),new IOL implanted in the ciliary sulcus(3 eyes)and zonule breaking(1 eye)occurred during IOL replacement.Conclusions IOL opacification is related with the IOL material and calcium ion concentration on the IOL surface.IOL replacement surgery can improve visual acuity safely and effectively.
作者
谢晋
刘廷
黄钰森
吴晓明
代云海
Xie Jin;Liu Ting;Huang Yusen;Wu Xiaoming;Dai Yunhai(Qingdao Eye Hospital of Shandong First Medical University,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Shandong First Medical University&Shandong Academy of Medical Sciences,Qingdao 266071,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2021年第7期512-518,共7页
Chinese Journal of Ophthalmology
基金
国家自然科学基金 (81600721)。
关键词
晶体
人工
丙烯酸树脂类
晶体植入
眼内
亲水性人工晶状体混浊
Lenses,intraocular
Acrylic resins
Lens implantation,intraocular
Hydrophilic intraocular lens opacity
