Curative Effect of Cataract Phacoemulsification with Iris Posterior Synechia

International Journal of Ophthalmology & Visual Science Pub Date : 2021-10-15 DOI:10.11648/J.IJOVS.20210604.11

Sun Tangsheng, Chen Liangju, Zhao Guangyu, Liu Lijuan, Hong Linyong

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Abstract

Background: Uveitis can cause blindness if not be appropriately managed. Anterior segment is common and frequent site in uveitis, can result in different degrees iris posterior synechia, iris depigmentation and atrophy, earlier form of cataract, etc. Surgery of cataract is complicated and prone to inflammatory reaction, especially in patients who involve anterior and posterior segment. Better operation technique and gentle maneuver is very important in such surgery. Aim: To investigate the application of phacoemulsification with IOLs implantation in cataract surgery with posterior synechia of the iris, and analyze its clinical effect. Methods: 36 cases (45 eyes) were enrolled from March 2019 to October 2020, 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%), pigmentation lost on IOLs in 7 eyes (15.6%). 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 debonded, 3 eyes (6.7%) with iris dystrophy. Average IOP was 11.27±6.81mmHg, 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. 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±5.71mmHg) was no change as preoperation (t=0.67, p=0.51). 4 (8.9%) and 3 (6.7%) eyes with iris posterior synechia and iris dystrophy respectively. Conclusion: Phacoemulsification and intraocular lens implantaion may be effective in the cataract surgery with iris posterior synechia, and timely mangement of possible complications after surgery maybe helpful for clinical outcomes.

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白内障超声乳化术合并虹膜后粘连的疗效观察

背景:葡萄膜炎如果处理不当可导致失明。前节段是葡萄膜炎的常见病和多发部位，可导致不同程度的虹膜后粘连、虹膜色素沉着和萎缩、早期形成白内障等。白内障手术复杂，易发生炎症反应，尤其是累及前、后节段的患者。良好的手术技术和轻柔的手法对此类手术至关重要。目的:探讨超声乳化联合人工晶状体植入术在虹膜后粘连白内障手术中的应用，并分析其临床效果。方法:选取2019年3月至2020年10月诊断为慢性葡萄膜炎并发白内障的36例(45眼)，行超声乳化吸出联合人工晶状体植入术。记录术后视力及术中并发症。结果:术后第1天，最佳矫正视力(BCVA)≥0.5 25眼(55.6%)，0.3~0.5 14眼(31.1%)，0.1~0.25 6眼(13.3%);出现前房炎症9眼(20.0%)，较严重及复发虹膜后粘连8眼(17.8%)，人工晶状体色素丧失7眼(15.6%)。术后眼压(IOP)为14.35±9.43mmHg(高于正常11眼，6.0~25.0mmHg)，与术前比较差异无统计学意义(t=0.25, p=0.80)。未发现感染性眼内炎。术后1周BCVA≥0.5 30眼(66.7%)，0.3~0.5 13眼(28.9%)，0.1~0.25 2眼(4.4%)。所有病例前房炎症均消失，虹膜后粘连不能剥离4眼(8.9%)，虹膜营养不良3眼(6.7%)。平均眼压为11.27±6.81mmHg，与术前比较差异无统计学意义(t=0.46, p=0.65)。术后1个月BCVA≥0.5 30眼(66.7%)，0.3~0.5 13眼(28.9%)，0.1~0.25 2眼(4.4%)。眼压(10.92±5.94mmHg)稳定，与术前比较差异无统计学意义(t=0.51, p=0.61)。术后3个月BCVA≥0.5 33眼(73.3%)，0.3~0.5 10眼(22.2%)，0.1~0.25 2眼(4.4%)。眼压(11.06±5.71mmHg)与术前无明显差异(t=0.67, p=0.51)。虹膜后粘连4眼(8.9%)，虹膜营养不良3眼(6.7%)。结论:超声乳化术联合人工晶状体植入术治疗虹膜后粘连白内障是有效的，及时处理术后可能出现的并发症有助于提高临床疗效。

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International Journal of Ophthalmology & Visual Science

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