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目的探讨马方综合征晶状体半脱位的不同手术治疗技巧及术后临床效果观察。方法根据术中观察的晶状体半脱位情况,分别采用以下四种手术方法：超声乳化晶状体吸除加改良带钩张力环(CTR)加折叠式后房型人工晶状体(PC IOL)植入术、超声乳化晶状体吸除加虹膜拉钩囊袋固定加折叠式PC IOL双襻睫状沟固定术,超声乳化晶状体吸除加折叠PC IOL双襻睫状沟固定术,以及晶状体囊内摘除加硬性PC IOL双襻睫状沟固定术。观察术后最佳矫正视力、CTR和IOL位置；术中和术后并发症。结果临床治疗20眼,术后视力均显著提高。术中的并发症主要为玻璃体脱出,多发生于囊内手术患者,行前部玻璃体切除后手术仍可顺利进行。UBM和后反光裂隙照相显示1双襻固定眼出现人工晶体稍倾斜,其余人工晶状体及CTR位置正常。10眼发生后囊膜混浊,IOL囊袋外植入的发生率达100%,其中1眼需行Nd：YAG激光后囊膜切开术。1眼发生瞳孔阻滞性青光眼,行激光周边虹膜切除术后眼压正常。无其他手术合并症的发生。结论改良带钩CTR和虹膜拉钩的应用实现半脱位晶状体原位超声乳化和IOL手术,前者还可维持术后囊袋的长期稳定性,是最佳的手术方式。根据患者和医生的具体情况选择最适宜的手术方式,是马方综合征晶状体半脱位患者术后视力获得良好恢复的关键。
Objective To investigate the surgical treatment of subluxation of Marfan syndrome and its clinical observation. Methods According to the intraoperative observation of subluxation of the lens, the following four surgical methods were used: phacoemulsification combined with modified crooked loop (CTR) plus foldable posterior chamber intraocular lens (PC IOL) implantation, phacoemulsification Lens aspiration and iris pull Hook sack fixation and folding PC IOL Double ciliary ciliary fixation, phacoemulsification and astigmatic PC IOL double ciliary ciliary fixation, and intracapsular enucleation plus rigid PC IOL double 襻Ciliary sulcus fixation. Postoperative best corrected visual acuity, CTR and IOL position were observed; intraoperative and postoperative complications were observed. Results The clinical treatment of 20 eyes, postoperative visual acuity were significantly improved. Intraoperative complications are mainly vitreous prolapse, occurred in patients with intracapsular surgery, the line after the anterior vitrectomy surgery can be carried out smoothly. UBM and retroreflective fissure photography showed a double tilt angle fixed intraocular lens appears slightly tilted, the rest of the intraocular lens and CTR normal position. Posterior capsular opacification occurred in 10 eyes. The incidence of IOL capsular implantation was 100%. One of them underwent Nd: YAG laser capsulotomy. IOP pupillary block glaucoma, IOP after laser peripheral iridectomy normal. No other surgical complications occurred. Conclusion The application of improved hook with hook and iris pull hook in situ phacoemulsification for phacoemulsification and IOL surgery, the former also can maintain the long-term stability of the postoperative capsule is the best surgical approach. According to the specific conditions of patients and doctors choose the most appropriate surgical approach is the key to good recovery of postoperative visual acuity in patients with Marfan syndrome subluxation of the lens.