白内障术后晚期人工晶状体脱位的研究进展

晚期人工晶状体脱位是白内障超声乳化吸除伴人工晶状体植入术后最严重的晚期并发症之一,晚期人工晶状体脱位是指行白内障手术3mo以后的脱位.不同于早期人工晶状体脱位,晚期自发性人工晶状体脱位主要是由于悬韧带断裂和囊袋收缩,通常在白内障手术后数年才发生.近些年来,晚期自发性人工晶状体脱位的发生率逐渐升高,10a后的累计发生率为0.1%,25a后为1.7%.在白内障术后长期随访病例中,90%患者存在悬韧带功能不全和/或囊袋收缩.多个因素可能导致晶状体悬韧带的脆弱和囊袋收缩,其中50%患者中可以观察到囊膜剥脱综合征,是最常见的原因,其他原因包括高龄、高度近视、葡萄膜炎、创伤、既往玻璃体切割手术史、视网膜色素变性、特应性皮炎、糖尿病、既往曾发生过急性闭角型青光眼、患有结缔组织疾病.对于这些易感因素的认识,有助于我们以后对高风险患者进行必要的预防.     

In-the-bag intraocular lens dislocation

PURPOSE: To describe the presenting characteristics and management alternatives of posterior chamber intraocular lens (PC-IOL) dislocation secondary to dehiscence of the zonules supporting the capsular bag. DESIGN: Observational case series. METHODS: Multicenter retrospective analysis of the surgical treatment and predisposing factors associated with 25 eyes of 22 patients with dislocation of the PC-IOL encased within the capsular bag secondary to dehiscence of the zonules supporting the capsular bag. RESULTS: The dislocated in-the-bag PC-IOL was replaced with an anterior chamber intraocular lens in 60% or repositioned/exchanged and scleral fixated in 40% of eyes. Associated conditions included pseudoexfoliation syndrome 44%, uveitis 16%, and trauma 16%. There was no identifiable cause in 24% of eyes. CONCLUSIONS: In-the-bag PC-IOL dislocations are an unusual, sometimes bilateral, late complication of cataract surgery that can be managed by exchange with an anterior chamber intraocular lens or by PC-IOL repositioning or replacement with scleral fixation. The most common associated condition was pseudoexfoliation.     

Spontaneous late in-the-bag intraocular lens dislocation after can-opener capsulotomy: case report

We report a case of a 58-year-old man presenting with a spontaneous and late in-the-bag intraocular lens dislocation to the vitreous. A previous uneventful extracapsular cataract extraction with can-opener style capsulotomy and implantation of a polymethylmethacrylate three-piece lens was performed and, two years after the surgery, the patient developed capsule contraction syndrome with a fibrotic ring formation and dislocation of the intraocular lens. Although uncommon and related mainly to continuous curvilinear capsulorhexis, capsule contraction syndrome occurs in patients undergoing extracapsular cataract surgery with can-opener style and polymethylmethacrylate lens implantation, and can be the causative factor of intraocular lens dislocation.     

Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients

PURPOSE: To identify a delayed complication of cataract surgery in patients with zonular weakness caused by pseudoexfoliation syndrome. DESIGN: Retrospective observational case series. PARTICIPANTS: Eight eyes in seven patients with clinically diagnosed pseudoexfoliation syndrome who had undergone previous uncomplicated cataract extraction and placement of a posterior chamber intraocular lens. METHODS: This study evaluated eight cases of late spontaneous dislocation of posterior chamber intraocular lenses within the capsular bag in patients with pseudoexfoliation syndrome. Data were gathered retrospectively from patients' operative reports, medical records, and pathology reports. MAIN OUTCOME MEASURES: (1) Interval between original surgery and dislocation; (2) final best-corrected visual acuity and ocular outcome. RESULTS: All patients had a diagnosis of pseudoexfoliation syndrome and had previously undergone uncomplicated cataract surgery. No patient had any other predisposing factors that would lead to zonular dehiscence or weakness. Delayed dislocation of the entire capsular bag containing the intraocular lens (IOL) occurred spontaneously in all cases. Mean time from IOL implantation to dislocation was approximately 85 months (7 years and 1 month; range, 57-115 months) after surgery. Seven eyes were treated successfully with IOL exchange: six with placement of an anterior chamber IOL and one with scleral fixation of a posterior chamber IOL. The remaining case was treated by scleral fixation of the dislocated IOL. Gross pathology analysis of seven cases confirmed the presence of the IOL within the intact capsular bag. Six eyes have achieved final best-corrected visual acuity of 20/40 or better. CONCLUSION: Patients with pseudoexfoliation syndrome may be at risk for delayed spontaneous dislocation of IOL within the capsular bag after uncomplicated cataract surgery. Awareness of this newly recognized long-term complication may justify a reevaluation of surgical considerations for cataract removal in these patients.     

外伤性人工晶状体移位的处理

目的 探讨眼外伤致人工晶状体移位的临床处理及疗效。方法 对12例(12眼)外伤致人工晶状体移位者，根据各自的情况分别实行不同的手术方式，观察术后视力改善情况。结果 实行手术的10眼视力均得到了提高，未见严重并发症发生。术后矫正视力：0．2者1眼，0．3～0．6者7眼，0．8～1．0者2眼。结论 外伤性人工晶状体移位只要及时恰当的治疗，仍可取得良好的临床效果。     

晶体脱位处理联合人工晶体植入

总结３７例（３８只眼）处理晶体脱位并同期行人工晶体植入的经验。本文的病例晶体脱位各异，以外为主，包括半脱位及全脱位于前房、玻璃体及视网前，处理方法均采用手术治疗，采用不同的术式去除脱位晶体，同时入前房型或后房型人工晶体。结果表明，治疗后的力均有没程度提高，且并发症少，提示手术效果令人满意。本文讨论了去除晶体的各种术式和植入人工晶体的类型及方法的选择经验。     

Clinical Characteristics of recurrent intraocular lens dislocation after scleral-fixated sutured intraocular lens and long-term outcomes of intraocular lens re-fixation

Graefe's Archive for Clinical and Experimental Ophthalmology - This study aimed to investigate the clinical characteristics of patients with recurrent intraocular lens (IOL) dislocation after...     

人工晶状体悬吊植入术后人工晶状体脱位的原因分析

背景 目前人工晶状体(IOL)悬吊植入术的操作技术逐渐进步,但术后远期IOL位置的稳定性仍不十分理想. 目的 探讨IOL悬吊植入术后发生IOL脱位的原因. 方法 本研究为回顾性系列病例观察研究.纳入1998-2009年于北京爱尔英智眼科医院因无晶状体眼行IOL悬吊植入术者321例321眼,本组中保持有效随访者共263例263眼,其中随访时间在5年以上者共164例164眼.所有患者术后5年以内(含5年)均未出现IOL脱位.对纳入分析的164例患者术后IOL脱位情况进行分析,对术中所用IOL材料、IOL植入位置、IOL植入时间以及术后眼压等与IOL脱位的关系进行统计,分析导致IOL脱位的原因,并对IOL脱位后的处理方法和结果进行分析和总结.结果 本组患者随访期在5年以上的164例164眼中术后发生IOL脱位者共9例9眼,占5.49％,IOL脱位时间在术后7～10年.从脱位IOL复位术中证实IOL脱位的主要原因是无明显诱因的悬吊线断裂,IOL固定于非水平对角位者IOL脱位发生率高于IOL固定于水平位者.IOL脱位的患者中以外伤性视网膜脱离患者比例最高,占33.33％.发生脱位的IOL均为一片式悬吊IOL,三片式折叠IOL植入者均未发生脱位.结论 IOL悬吊植入术中IOL的固定缝线断裂是IOL脱位的主要原因,悬吊线断裂可能与非水平对角位固定IOL时的重力有关,因此建议术中采用3:00 ～9:00位水平固定IOL.     

后房型人工晶状体脱位的研究现状

人工晶状体脱位是白内障摘除联合后房型人工晶状体植入术后较为常见的并发症之一。手术中截囊不完全、撕囊不均、悬韧带和(或)后囊破裂、皮质残留、囊袋收缩、渗出膜及机化条带牵制、后发性白内障及外伤等因素均可导致植入的后房型人工晶状体脱位。目前针对后房型人工晶状体脱位,可采用单纯人工晶状体复位、囊袋张力环植入、前房型人工晶状体植入、悬吊式人工晶状体植入、人工晶状体取出以及玻璃体切割术等。