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目的 评价因复杂眼外伤或视网膜脱离行玻璃体手术和晶状体切除术后 ,二期手术植入人工晶状体 (intraocular lens,IOL)的视力效果、手术技术及其安全性。 方法 对在 1996年 11月至 1999年 12月之间在我院进行该手术的 32例 (32只眼 ,每例均为单眼 )行回顾性分析。二期手术中应用经睫状体平部的眼内灌注 ,并根据晶状体囊膜完整性选择不同类型的 IOL。 结果 本组包括复杂眼外伤 30例 (眼后节异物伤 15例 ,穿通伤伴外伤性眼内炎及玻璃体积血各 6例 ,钝挫伤伴晶状体脱位 3例 ) ;原发性视网膜脱离 2例。均接受过玻璃体切割、晶状体切割 ,或眼内异物取出、角膜缝合等。 2次手术的间隔为 1～ 16个月 ,平均(6 .8± 3.7)个月。在 2 5例晶状体囊环完整或存留 2 / 3以上的眼植入后房型 IOL于睫状沟内 ;5例作了 IOL的透巩膜缝线固定术 ;植入前房型或带虹膜 IOL 各 1例。 5例同期放出硅油。手术后 2 9例视力提高。主要并发症为角膜水肿及低眼压。 结论 在玻璃体手术后的二期手术中 ,应用眼内灌注和适当的 IOL 植入 ,可使经选择的无晶状体眼安全获得较好的视力恢复。
Objective To evaluate the visual acuity, surgical technique and safety of secondary intraocular lens (IOL) after vitrectomy and vitrectomy complicated with ocular trauma or retinal detachment. Methods Retrospective analysis was performed on 32 patients (32 eyes, each being monocular) who underwent surgery in our hospital from November 1996 to December 1999. Intraocular perfusion of the transected ciliary body during the second phase of surgery was performed and different types of IOL were selected according to the capsular integrity of the lens. Results The group included 30 cases of complex ocular trauma (15 cases of foreign body injury in the posterior segment, 6 cases of traumatic endophthalmitis and vitreous hemorrhage, 3 cases of blunt contusion and lens dislocation), 2 cases of primary retinal detachment . Have received vitrectomy, lens cutting, or removal of intraocular foreign body, corneal suture. The interval between two operations was 1 to 16 months, with an average of (6. 8 ± 3.7) months. In 25 cases of lens capsular ring complete or more than 2/3 of eye retention after IOL implantation in the ciliary sulcus; 5 cases made IOL transscleral suture fixation; anterior chamber implantation or iris IOL each 1 example. 5 cases released silicone oil over the same period. 29 cases after surgery increased visual acuity. The main complications are corneal edema and hypotension. Conclusions Intraocular perfusion and proper IOL implantation in the second stage of vitreoretinal surgery may provide a better recovery of visual acuity in selected aphakia.