飞秒激光辅助超声乳化白内障吸除联合张力环及人工晶状体植入术治疗晶状体不全脱位的临床观察

目的观察飞秒激光辅助超声乳化白内障吸除联合张力环及人工晶状体植入术在晶状体不全脱位(SL)治疗中的安全性与有效性。 方法收集2017年10月至2019年3月就诊于广州爱尔眼科医院的SL患者22例(26只眼)的病例资料。其中，男性患者18例(21只眼)，女性患者5例(5只眼)；年龄5~65岁，平均(45.8±18.2)岁；外伤性的SL 14例(14只眼)、马凡综合征SL 5例(9只眼)及自发性(原因不明)的SL 3例(3只眼)。按SL程度分，本研究中11只眼脱位轻度，7只眼脱位中度，8只眼脱位重度。采用飞秒激光辅助超声乳化白内障吸除联合张力环及人工晶状体植入术治疗SL，观察并记录术中和术后并发症的情况；检查术后视力、眼压；观察并记录囊袋的稳定性和人工晶状体的居中情况。手术前后患者的最佳矫正视力采用眼数和百分比进行描述；术前、术后的比较采用Wilcoxon检验。 结果本研究纳入的22例(26只眼)患者的手术均顺利，人工晶状体成功植入囊袋内。术中并发症主要有球结膜下出血(20/26只眼)、激光前囊膜未完全切开(5/26只眼)和瞳孔缩小(4/26只眼)。术后无黄斑水肿、眼内炎及视网膜脱离等并发症。本研究中26只眼术后视力均有不同程度的提高。其中，术前最佳矫正视力≥0.5者为2只眼；术后最佳矫正视力≥0.5者为14只眼。术前最佳矫正视力0.3~0.5者为2只眼；术后最佳矫正视力0.3~0.5者为8只眼。经Wilcoxon统计学检验，发现术前、术后最佳矫正视力的差异具有统计学意义(Z＝-4.46，P<0.05)。术后20例(24只眼)人工晶状体的居中性良好，2例(2只眼)人工晶状体发生轻度移位，3例(3只眼)人工晶状体出现前囊膜皱缩。 结论飞秒激光辅助超声乳化白内障吸除联合张力环及人工晶状体植入术在SL治疗中是一种安全有效的方法，其不仅可提高撕囊的成功率，降低超声乳化手术难度，保持囊袋的稳定性，亦可减少术后并发症，临床效果良好。

Clinical observation of femtosecond laser-assisted with phacoemulsification surgery of cataracts combined with tension ring and intraocular lens implantation in the treatment of subluxated lens

ObjectiveThe aim of this study was to observe the safety and effectiveness of femtosecond laser-assisted with phacoemulsification surgery of cataracts combined with tension ring and intraocular lens implantation in the treatment of subluxated lens (SLs). Methods22 cases of 26 eyes with SL were enrolled in Guangzhou Aier Eye Hospital from October 2017 to March 2019, including 18 male (21 eyes), 5 female (5 eyes); the age range from 5-65, average age (45.8±18.2). Among of them, 14 cases of 14 eyes with traumatic lens subluxation, 5 cases of 9 eyes with Mafan syndromes, and 3 spontaneous cases of 3 eyes with unexplained reasons. According to the extent of zonular weakness, 11 eyes of them were mild; 7 eyes of them were medium, and 8 eyes of them were severe. The femtosecond laser-assisted with phacoemulsification surgery of cataracts combined with tension ring and intraocular lens implantation was used to perform, and intraoperative and postoperative complications were evaluated. Visual acuity and intraocular pressure after operation were recorded. The stability of capsular bag and intraocular len were assessed. The best corrected visual acuity (BCVA) before and after surgery was described by the number and percentage of eyes. Wilcoxon testing was used to compare preoperative and postoperative visual acuity. ResultsAll the operations of 26 eyes were completed and SLs were implanted into capsular bag successfully. Intraoperative complications were mainly subconjunctival hemorrhage (20/26 eyes), incomplete capsulotomy (5/26 eyes) and contracted pupils (4/26 eyes). Postoperative complications such as macular edema, endophthalmitis and retinal detachment were not found. BCVA of 26 eyes after surgery was improved to some extent. Before the cataract surgery, the eyes with BCVA was ≥0.5, which had 2 patients; after cataract surgery, the eyes with BCVA was ≥0.5, which had 14 patients. Before cataract surgery, eyes with BCVA was between 0.3 and 0.5, which had 2 patients; after cataract surgery, eyes with BCVA was between 0.3 and 0.5, which had 8 patients. Compared with that before cataract surgery, the postoperative of BCVA was significantly improved (Z=-4.46, P<0.05). 24 SLs were stably centered; two intraocular lens were slightly displaced; and 3 eyes had anterior capsular contraction. ConclusionFemto second laser-assisted cataract surgery is an effective and safe approach for patients with SLs. This approach have shown the good clinical effect, including the increase in the successful rate of capsulorhexis, the decrease in the difficulty of phacoemulsification, and perioperative complications through preserving the stability of the capsular bag.