Objective: To evaluate the clinical efficiency of an iris hook combined with a modified double-eyelet capsular tension ring (MCTR) in the treatment of serious lens subluxation. Methods: Retrospective case series. A total of 16 patients (20 eyes) with serious lens subluxation were enrolled in Zhongshan Ophthalmic Center from March 2016 to December 2016. All the patients had an iris hook inserted to support the capsule during the phacoemulsification. Then an MCTR was implanted and sutured onto the sclera. Both intraoperative and postoperative complications, such as posterior capsular opacification and macular edema, were recorded. The postoperative examinations included visual acuity, intraocular pressure, slit-lamp examination, and Pentacam for evaluation of the positions of the capsule and the intraocular lens(IOL). The best corrected visual acuities before and after operation were compared with the matched t test. Results: There were 11 males(12 eyes) and 5 females (8 eyes) among the 16 patients (20 eyes) aged (36±16) years, including 5 cases of Marfan's syndrome (7 eyes), spontaneous ectopia lentis in 7 patients (9 eyes), and traumatic lens dislocation in 4 patients (4 eyes). All the MCTRs were successfully implanted into the capsule. The best corrected visual acuity ranged from 0.3 to 1.0, with 0.5 or higher accounting for 90% (18 eyes). It was 0.20±0.14 and 0.21±0.13, respectively, at 3 and 6 months, which was significantly better than the preoperative best corrected visual acuity (logarithm of the minimal angle of resolution) (0.74±0.51;t=5.302, P<0.001; t=5.131;P<0.001). One eye had macular edema 3 months after surgery, and then was treated by conservative management. Two eyes(2 case) developed mild posterior capsular opacification 6 months after operation. No intraocular hypertension was persistently observed. All IOLs and capsular bags were in the expected position without an obvious tilt or displacement. Conclusion: The surgical strategy of iris hooks combined with MCTRs in the treatment of serious lens subluxation could maintain long-term stability of the capsule. (Chin J Ophthalmol, 2018, 54: 343-348).
目的： 探讨虹膜拉钩联合双钩改良囊袋张力环（MCTR）在严重晶状体不全脱位治疗中的应用效果。 方法： 回顾性系列病例研究。收集2016年3至12月在中山大学中山眼科中心治疗的16例（20只眼）晶状体不全脱位患者的资料，所有患者在虹膜拉钩辅助下行超声乳化白内障吸除联合人工晶状体（IOL）植入术，术中植入双钩MCTR并固定于巩膜瓣下。记录术中并发症；术后3、6个月随访，观察视力、眼压，使用裂隙灯显微镜以及眼前节分析仪（Pentacam）确定晶状体囊袋、IOL位置，记录有无后发性白内障、黄斑水肿等并发症。患者手术前后的最佳矫正视力比较采用配对t检验。 结果： 16例（20只眼）患者中男性11例（12只眼），女性5例（8只眼），年龄（36±16）岁；其中马方综合征5例（7只眼）、自发性晶状体不全脱位7例（9只眼）、外伤性晶状体不全脱位4例（4只眼）。20只眼均成功植入双钩MCTR。随访患者最佳矫正视力为0.3~1.0，其中≥0.5者占90%（18/20）；术后3、6个月最佳矫正视力（最小分辨角对数视力为0.20±0.14、0.21±0.13）较术前（0.74±0.51）明显提高，差异有统计学意义（t=5.302，P<0.001；t=5.131，P<0.001）。术后3个月随访发现1例（1只眼）黄斑水肿，经眼底内科治疗后逐渐好转；术后6个月随访发现2例（2只眼）有轻度晶状体后囊膜混浊。所有患者眼压无持续升高，IOL及晶状体囊袋未见明显偏位。 结论： 虹膜拉钩联合双钩MCTR植入术可作为治疗严重晶状体不全脱位的术式选择，术后可维持晶状体囊袋的稳定性。（中华眼科杂志，2018，54：343-348）.
Keywords: Lens implantation, intraocular; Lens subluxation; Lenses, intraocular; Phacoemulsification.