STRUCTURAL ANALYSIS AND COMPREHENSIVE SURGICAL OUTCOMES OF THE SUTURELESS INTRASCLERAL FIXATION OF SECONDARY INTRAOCULAR LENSES IN HUMAN EYES.
STRUCTURAL ANALYSIS AND COMPREHENSIVE SURGICAL OUTCOMES OF THE SUTURELESS INTRASCLERAL FIXATION OF SECONDARY INTRAOCULAR LENSES IN HUMAN EYES.
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DOI：
10.1097/iae.0000000000001941
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发表时间：
2018-09
期刊：
影响因子：
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通讯作者：
Wolfe JD
中科院分区：
文献类型：
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作者：
Todorich B;Stem MS;Kooragayala K;Thanos A;Faia LJ;Williams GA;Hassan TS;Woodward MA;Wolfe JD
描述经结膜无缝线巩膜内（SIS）固定植入的人工晶状体在人眼中的手术结局和结构特征。涉及活体和尸体人眼的回顾性介入手术病例系列。在这项研究中，我们研究了在人眼中采用SIS技术植入二期IOL的手术结局和结构解剖。对2012年1月1日至2016年7月30日在一家学术中心进行的涉及SIS IOL固定的所有病例进行了审查，以描述手术技术、常见适应症、临床结局和常见手术并发症的发生率。为了研究SIS固定IOL的体内结构，对裂隙灯生物显微镜、超声生物显微镜（UBM）和术中内窥镜进行了分析，以描述解剖结局。主要的解剖结果是光学瞳孔中心和触觉外化的位置。结果与接受SIS-IOL技术的尸体人眼相关。使用高分辨率摄影对尸体眼进行成像和分析，以确定中心、支撑襻-光学部接合处的应力测量以及IOL光学部和支撑襻位置的定性描述符。本研究共纳入了122例采用SIS技术进行IOL植入的连续患者，平均随访时间为1.52年（范围：0.4-4.5年）。大多数（75%）患者因原发性无晶状体或IOL更换后接受了新的3件式IOL。其他患者（25%）的3件式IOL脱位，使用SIS技术进行了挽救。术前平均Snellen视力为20/633（logMAR=1.501）。末次访视时，平均最佳矫正视力为20/83（logMAR=0.6243），最终平均等效球镜为-0.57屈光度。最常见的并发症是玻璃体积血（22%的眼睛），大多数病例均可自发消退，以及囊样黄斑水肿。人工晶状体脱位、人工晶状体偏心、支撑襻腐蚀、人工晶状体倾斜、虹膜夹持和眼内炎的发生率较低。术中内窥镜检查和UBM显示IOL固定牢固，光学部居中，无虹膜或睫状体接触。尸体眼的结构研究证实了在真人手术期间观察到的IOL光学部和支撑襻解剖结构。内侧支撑襻位于睫状体平坦部前部，远离虹膜、睫状突和锯齿缘。触觉外化的程度与触觉-视觉连接处的应变程度相关。SIS固定IOL的支撑襻-光学部交界处角度（33.97°）与覆盖的自体非固定IOL（32.93°）相比无显著差异，但随着支撑襻头端外部化程度的增加略有增加（2 mm和3 mm支撑襻外部化分别为36.26 °和39.16°）。在这项综合性研究中，我们证明了SIS固定IOL的手术结局。手术和术后并发症确实会发生，尽管发生率很低，但可以有效地管理，并获得良好的解剖和视觉效果。本研究中的结构和解剖数据可能有助于指导SIS放置和优化长期手术结果。
To describe surgical outcomes and structural characteristics of IOLs implanted with transconjunctival sutureless intrascleral (SIS) fixation in human eyes. Retrospective interventional surgical case series involving live and cadaveric human eyes. In this study, we investigated the surgical outcomes and structural anatomy of secondary IOLs implanted with the SIS technique in human eyes. All cases involving SIS IOL fixation performed at a single academic center from January 1 2012 through July 30 2016 were reviewed to describe the surgical technique, common indications, clinical outcomes, and the rate of common operative complications. In order to investigate the structure of SIS-fixated IOLs in vivo, slit-lamp biomicroscopy, ultrasound biomiscroscopy (UBM), and intraoperative endoscopy were analyzed to describe anatomic outcomes. The primary anatomic outcomes were the optic pupillary centration and location of haptic externalization. Results were correlated with cadaveric human eyes that underwent the SIS-IOL technique. Cadaveric eyes were imaged and analyzed using high-resolution photography for centration, stress measurements at the haptic-optic junction, and qualitative descriptors of IOL optic and haptic position. A total of 122 consecutive patients that underwent IOL placement using SIS technique were included in the study with mean follow-up of 1.52 years (range, 0.4–4.5 years). The majority (75%) of patients received a new 3-piece IOL for primary aphakia or after IOL exchange. The other patients (25%) had a dislocated 3-piece IOL that was rescued using the SIS technique. Preoperative mean Snellen visual acuity was 20/633 (logMAR=1.501). At the final visit, the mean best-corrected visual acuity was 20/83 (logMAR=0.6243) and final mean spherical equivalent was −0.57 diopters. The most common complications were vitreous hemorrhage (22% of eyes), which resolved spontaneously in majority of cases, and cystoid macular edema. The rates of IOL dislocation, IOL decentration, haptic erosion, IOL tilting, iris capture and endophthalmitis were low. Intraoperative endoscopy and UBM demonstrated a securely fixated IOL, and well-centered optic without iris or ciliary body touch. Structural study of cadaveric eyes confirmed IOL optic and haptic anatomy observed during live human surgery. The ab interno haptic insertion was the anterior pars plana, away from iris, ciliary processes and ora serrata. The degree of haptic externalization was correlated with the degree of strain on the haptic-optic junction. The angle of the haptic-optic junction in SIS-fixated IOLs (33.97°) was not significantly different compared to overlaid native non-fixated IOL (32.93°), but increased slightly with degree of haptic tip externalization (36.26 ° and 39.16° for 2mm and 3mm haptic externalizations, respectively). In this comprehensive study, we demonstrate the surgical outcomes achieved with SIS fixation of IOLs. Surgical and post-operative complications do occur, albeit at a low rate, and can effectively be managed with excellent anatomic and visual outcomes. The structural and anatomic data in this study may help guide SIS placement and optimize long-term surgical results.