关键词: 先天性晶状体半脱位, 囊袋张力环, 巩膜缝合固定, IOL脱位

Abstract: Objective To evaluate the outcome of two surgical approaches, phacoemulsification combined with capsular tension ring(CTR) and intraocular lens (IOL) implantation vs. pars plana lensectomy/ vitrectomy (PPL+PPV) combined with sclera-sutured IOL implantation for congenital subluxation of the lens. Design Retrospective cases series. Participants 82 cases (146 eyes) of congenital subluxation of the lens in Beijing Tongren Hospital from 2003 to 2008. Methods All cases were divided into two groups. Group 1, phacoemulsification combined with CTR and IOL implantation (Phaco+CTR+IOL) were performed in 40 cases (72 eyes) which range of lens dislocation was less than 120 degree and followed up from 3 weeks to 26 months. Group 2, pars plana lensectomy/vitrectomy combined with sclera-sutured IOL implantation (PPL+PPV+ IOL) were performed in 42 cases (74 eyes) which range of lens dislocation were 120 degree or more and followed up from 1 week to 38 months. Postoperative best corrected LogMAR visual acuity (BCVA), and IOL location, IOP were recorded. Main Outcome Measures Postoperative BCVA, IOP, IOL location and complications. Results In Phaco+CTR+IOL group, 34 patients (59 eyes, 81.9%) identified with CTR-IOL complex dislocation which underwent repositioning surgery. The median interval from CTR implantation to its dislocation was 3 months. The rate of low IOP after Phaco+CTR+IOL surgery was 18.1%, and the rate of low IOP after repositioning of CTR-IOL complex was 20.34%. In PPL+PPV+IOL group, the postoperative BCVA was (0.42±0.20), the rate of low IOP after surgery was 36.5%. IOL capture of pupil was noted in 4 cases (5 eyes), leakage of scleral incision in 2 cases (2 eyes), and temporary choroidal detachment in 1 case (1 eye). Postoperative BCVA between the two groups showed no significant difference (P>0.50). The rate of postoperative low IOP between the two groups showed no significant difference. Conclusions Optimal visual outcomes can be achieved by Phaco+CTR+IOL or PPL+PPV+IOL in congenital subluxation of the lens. PPL+PPV+IOL procedure may reduce IOL dislocation complication, otherwise increase the opportunity of postoperative ocular hypotension over Phaco+CTR+IOL technique. (Ophthalmol CHN, 2015, 24: 47-50, 55)

Key words: congenital subluxation of the lens, capsular tension ring, scleral-suture fixation, IOL dislocation