【摘要】 目的 探讨超声乳化在伴有虹膜后粘连白内障手术中的应用，分析其疗效。方法 选取2014年3月至2016年10月在我院诊治的陈旧性前葡萄膜炎并发白内障的患者36例45眼，皆存在不同程度的虹膜的后粘连，所有患者接受白内障超声乳化手术联合人工晶体植入，分析总结术中、术后并发症以及视功能恢复情况。 结果 术后第1天，最佳矫正视力≥0.5者25眼（55.6%），0.3~0.5者14眼（31.1%），0.1~0.25者6眼（13.3%）。出现前房反应者9眼（20.0%），程度较重且虹膜再次出现后粘连者8眼（17.8%），人工晶体表面色素明显增多者7眼（15.6%），均及时使用糖皮质激素合并散瞳药物并密切随访。术后第1天眼压 14.35±9.43 mmHg（超出正常眼压患者11眼，最高25.1mmHg，最低6.7mmHg），与术前眼压无差异（t=0.25，p=0.80）。未发现感染性眼内炎患者。术后1周，矫正视力≥0.5者30眼（66.7%），0.3~0.5者13眼（28.9%），0.1~0.25者2眼（4.4%）。所有患者前房反应消失，虹膜后粘连无法完全松解者4眼（8.9%），虹膜萎缩3眼（6.7%）。眼压11.27±6.81 mmHg，（皆恢复正常，最高19.6mmHg，最低7.8mmHg ），与术前眼压无差异（t=0.46，p=0.65）。术后1个月，矫正视力≥0.5者30眼（66.7%），0.3~0.5者13眼（28.9%），0.1~0.25者2眼（4.4%）。前房反应消失，虹膜后粘连及萎缩情况与术后1周一致。眼压保持稳定（10.92±5.94mmHg），与术前眼压无显著性差异（t=0.51，p=0.61）。术后3个月，矫正视力≥0.5者33眼（73.33%），0.3~0.5者10眼（22.2%），0.1~0.25者2眼（4.4%）。眼压维持稳定（11.06±5.71 mmHg），与术前眼压无显著性差异（t=0.67，p=0.51），前房无反应。仍维持虹膜后粘连者4眼（8.9%），虹膜萎缩3眼（6.7%）。结论 超声乳化手术可以安全有效地应用于伴虹膜后粘连白内障患者的治疗中，术后注意密切观察术眼的异常情况并及时处理，可以取得满意的临床效果。
【关键词】 葡萄膜炎；白内障；超声乳化
Curative effect of cataract phacoemulsification with iris posterior synechia
Chen Liangju, Sun Tangsheng, Zhao Guangyu, Liu Lijuan, Hong LinYong
Corresponding author: Sun Tang-sheng, Email: sunts629@163.com
【Abstract】 Objective To investigate the application of phacoemulsification in cataract surgery with posterior synechia of the iris. Methods 36 cases (45 eyes) were enrolled from March 2014 to October 2016, diagnosed with chronic uveitis complicated cataract, treated with phacoemulsification combined with implantation of intraocular lens. Postoperative visual acuity and complications during operation were recorded. Results Postoperative day 1, the best corrected visual acuity （BCVA） of 25 eyes (55.6%) were no less than 0.5, 14 eyes (31.1%) were 0.3~0.5 , 6 eyes (13.3%) were 0.1~0.25; Anterior chamber inflammation emerged in 9 eyes (20.0%), more severe and recurrence of iris posterior synechia in 8 eyes (17.8%), more pigmentation on IOLs in 7 eyes (15.6%) , with application of glucocorticoid, pupillary drugs and close follow-up. Intraocular pressure (IOP) after operation was 14.35±9.43mmHg (11 eyes were above normal, 6.0~25.0mmHg), no significance difference with preoperation IOP ( t=0.25，p=0.80 ). No infectious endopthalmitis was found. 1 week after operation, the BCVA of 30 eyes (66.7%) were no less than 0.5, 13 eyes (28.9%) were 0.3~0.5, 2 eyes (4.4%) were 0.1~0.25. Anterior chamber inflammation disappeared in all cases, 4 eyes (8.9%) with iris posterior synechia couldn’t be loose, 3 eyes (6.7%) with iris dystrophy. IOP was 11.27±6.81mmHg (all cases were normal, 7~19mmHg), no significance difference with preoperation IOP ( t=0.46，p=0.65 ). 1 month after operation, the BCVA of 30 eyes (66.7%) no less than 0.5, 13 eyes (28.9%) were 0.3~0.5, 2 eyes (4.4%) were 0.1~0.25. No anterior chamber inflammation in all cases, and no change in iris posterior synechia and iris dystrophy. IOP (10.92±5.94mmHg)was stable, and no significance difference with preoperation IOP (t=0.51，p=0.61). 3 months after operation, the BCVA of 33 eyes (73.3%) were no less than 0.5, 10 eyes (22.2%) were 0.3~0.5, 2 eyes (4.4%) were 0.1~0.25. IOP (11.06±5.71 mmHg) was no change with preoperation ( t=0.67，p=0.51 ), no anterior chamber inflammation in all cases. 4(8.9%) and 3(6.7%) eyes with iris posterior synechia and iris dystrophy respectively. Conclusions Phacoemulsification and intraocular lens implantaion may be effective in the cataract surgery with posterior synechia of the iris. And timely mangement of possible complications after surgery maybe helpful for clinical outcomes.
【Key words】 Uveitis; Cataract; Phacoemulsification
超声乳化手术治疗白内障在我国已经相当普遍，不但常规应用于普通的白内障手术，对于一些复杂的白内障，比如陈旧性前葡萄膜炎导致的并发性白内障，超声乳化手术也具有明显的优势。据统计，前葡萄膜炎在整个葡萄膜炎中最常见，国人的患病率达50%~60% [1]。前葡萄膜炎反复发作易发生虹膜与晶状体的粘连以及房水理化性质的改变，白内障的出现也会大大提前，治疗上具有一定的难度和特殊性。本文旨在从前葡萄膜炎伴虹膜后粘连的白内障超声乳化手术的安全性和有效性进行探讨。
资料与方法
1. 一般资料：选取2014年3月至2016年10月就诊于我院的陈旧性前葡萄膜炎并发白内障的患者36例45眼，其中男性21例26眼，女性15例19眼，年龄52.37±6.23岁（42~69岁）。患者病程6个月24年，平均（6.54±2.46年）；具有明确风湿和类风湿等全身免疫性疾病患者15例。术前使用典必殊滴眼液滴术眼每日4次，连用3天。双眼手术者，在一眼手术后至少1周再行对侧眼手术。
作者：陈良桔、孙堂胜、赵广愚、刘利娟、洪林勇