南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (07): 843-.doi: 10.12122/j.issn.1673-4254.2019.07.15

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飞秒激光技术在晶状体不全脱位手术中的应用

莒瑞红，陈韵，杨威，何曼莎，潘远红，武哲明   

  • 出版日期:2019-07-20 发布日期:2019-07-20

Application of femtosecond laser technology in the management of subluxated lens

  • Online:2019-07-20 Published:2019-07-20

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摘要： 目的评估飞秒激光辅助技术在晶状体不全脱位手术治疗中的临床应用。方法回顾性分析2017年3月~2019年5月期间 在广州爱尔眼科医院白内障中心就诊的晶状体不全脱位并接受飞秒激光辅助技术手术治疗的患者资料。手术采用LenSx飞秒 激光辅助白内障手术系统进行前囊膜切开、预劈核，之后根据患者眼部情况行前段玻璃体切除或囊袋拉钩固定前囊口，超声乳 化吸除晶状体核，I/A吸除皮质，最后植入张力环和人工晶状体。记录术前患者一般资料，术中情况，术后视力、眼压、囊袋、IOL 情况及并发症的情况。结果共纳入研究25例29眼。外伤所引起的晶状体不全脱位16例16眼（55.17%），马凡综合征所致晶状 体不全脱位5 例9 眼（31.03%），高度近视引起的晶状体不全脱位1 例1 眼（3.45%），原因不明的晶状体不全脱位3 例3 眼 （10.34%）；轻度，中度和重度晶状体不全脱位分别为13眼（44.83%），7眼（24.14%），9眼（31.03%）。29眼（100%）均顺利完成飞 秒激光辅助撕囊、预劈核、白内障超声乳化吸除，其中28 眼（96.55%）保留了完整的囊袋并植入囊袋辅助装置及IOL；9 眼 （31.03%）行前段玻璃体切除术；2眼（6.90%）使用虹膜拉钩，9眼（31.03%）使用囊袋拉钩。术后29眼最佳矫正视力与术前相比， 均有明显改善，差异具有统计学意义（P<0.05）。术后1月后26眼（89.66%）IOL的居中性良好，2眼（6.90%）IOL发生轻度移位，3 眼（10.34%）出现前囊膜皱缩。术中并发症主要有球结膜下出血22眼（75.87%），前囊口切开不完全5眼（17.24%），瞳孔缩小4眼 （13.79%）等。结论飞秒激光辅助技术的应用使得晶状体不全脱位手术治疗更加安全、有效，为个性化的手术方案选择和最大 限度的恢复患者的视功能提供了更好的保障。

Abstract: Objective To evaluate the application of femtosecond laser technology in the management of subluxated lens. Methods We retrospectively analyzed the data of the patients with subluxated lens undergoing femtosecond laser- assisted surgery at the Cataract Center of Guangzhou Aier Eye Hospital between March, 2017 and May, 2019. The LenSx femtosecond laser-assisted cataract surgery system was used to perform capsulotomy and lens fragmentation. According to the patients’ eye condition, anterior vitrectomy was performed and capsular retractors was used. After phacoemulsification, I/A and insertion of the tension rings, the intraocular lens (IOL) was implanted into the capsular bag. The perioperative data, complications, visual acuity and intraocular pressure after the operation were recorded, and the stability of the capsular bag and IOLs were assessed. Results We analyzed the data of 25 cases (29 eyes) of subluxated lens, including 16 (16 eyes; 55.17%) as the result of traumatic lens subluxation, 5 (9 eyes; 31.03%) of Mafan syndromes, 1 case (1 eye; 3.45%) of high myopia and 3 cases (3 eyes; 10.34%) of unknown causes. Thirteen 13 eyes (44.83%) showed mild subluxation, 7 (24.14%) had moderate subluxation, and 9 (31.03% ) had severe subluxation. Femtosecond laser- assisted capsulorhexis, lens fragmentation and phacoemulsification were successfully completed for 29 eyes, of which 28 eyes (96.55%) retained the complete capsular bag and with successful implantation of the capsular tension devices and IOLs. Nine eyes (31.03%) were treated with anterior segment vitrectomy; iris hooks were used for 2 eyes (6.90%) and capsular bag hooks for 9 eyes (31.03%). The best corrected visual acuity was significantly improved in 29 eyes after operation (P<0.05). At 1 month after the surgery, 26 eyes (89.66%) showed stably centered IOLs, 2 eyes (6.90% ) showed slight tilt of the IOLs, and 3 eyes (10.34% ) had anterior capsular contraction. The intraoperative complications included subconjunctival hemorrhage (75.87% ), incomplete capsulotomy (17.24%) and contracted pupils (13.79%). Conclusions The application of femtosecond laser assisted technology enhances the surgical safety and effectiveness for subluxated lens, facilitates the choice of individualized surgical options, and promotes maximum recovery of the patients’ visual function.