Intraocular lens implantation in combination with lensectomy and vitrectomy for persistent fetal vasculature
Intraocular lens implantation in combination with lensectomy and vitrectomy for persistent fetal vasculature
复制标题
人工晶状体植入联合晶状体切除术和玻璃体切除术治疗持续胎儿血管系统
DOI：
10.1007/s00417-020-04880-9
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发表时间：
2020
影响因子：
2.7
通讯作者：
Zhao Peiquan
中科院分区：
文献类型：
--
作者：
Lyu Jiao;Zhao Peiquan
目的探讨人工晶状体（IOL）植入术联合晶状体切除和玻璃体切除治疗持续性胎儿脉管炎（PFV）的手术效果。方法对19例单侧合并PFV患者的19只眼进行介入治疗。晶状体缘晶状体切除术、囊状体切除术、玻璃体前部切除术、晶状体后膜和晶状体柄剥离、囊内或沟内人工晶状体植入术，用于治疗有晶状体后纤维血管膜和晶状体柄存在的晶状体混浊，在有足够囊状体支持的眼睛中进行。评估术后解剖和视觉结果。结果随访22 ~ 50个月，19眼中18眼（95%）人工晶状体就位。所有8只存在乳头周围牵引性视网膜病变的眼睛视网膜拖拽均逆转。主要并发症2眼（11%），1眼（5.5%）为玻璃体出血和后囊膜混浊，1眼（5.5%）为人工晶状体脱位。19只眼中有9只（47%）的最佳矫正视力（BCVA）在20/200以上。与BCVA较差的眼相比，BCVA > 20/200的眼术前BCVA较好（平均20/400比20/4000，P= 0.004），且既往存在乳头周围牵拉性视网膜病变的可能性较低（11%比70%，P= 0.002）。结论人工晶体植入术联合晶状体、玻璃体切除术是治疗合并PFV眼的一种选择。术前视力不佳和术前存在牵引性视网膜病变可能限制了康复的前景。术后屈光状态需要长期监测。
PurposeTo present surgical outcomes following intraocular lens (IOL) implantation in combination with lensectomy and vitrectomy for the treatment of persistent fetal vasculature (PFV).MethodsThis interventional case series included 19 eyes from 19 patients with unilateral combined PFV. Limbal lensectomy, capsulotomy, anterior vitrectomy, dissection of the retrolental membrane and stalk, and in-the-bag or in-the-sulcus IOL implantation were performed for the treatment of visually significant lenticular opacity with the presence of a retrolental fibrovascular membrane and stalk, in an eye with sufficient capsular support. Postoperative anatomical and visual outcomes were evaluated.ResultsAfter 22 to 50 months of follow-up, IOLs were well positioned in 18 (95%) of 19 eyes. Retinal dragging was reversed in all 8 eyes with preexisting peripapillary tractional retinopathy. Major complications occurred in 2 eyes (11%): one eye (5.5%) of vitreous hemorrhage and posterior capsular opacity and one eye (5.5%) of IOL dislocation. Nine (47%) of 19 eyes achieved best-corrected visual acuity (BCVA) above 20/200. Myopic shift after IOL implantation ranged from 0.75 to 4.17 D. Compared with eyes with poorer BCVA, eyes with BCVA above 20/200 had a better preoperative BCVA (mean 20/400 vs. 20/4000,P= 0.004) and were less likely to have preexisting peripapillary tractional retinopathies (11% vs. 70%,P= 0.002).ConclusionPrimary IOL implantation in combination with lensectomy and vitrectomy is an alternative to treat eyes with combined PFV. Prospects for rehabilitation may be limited by poor preoperative visual function and the presence of tractional retinopathies preoperatively. Postoperative refractive status requires long-term monitoring.