摘要目的 总结临床行人工晶状体置换术的原因、手术方法及效果,分析手术原因的变化,探讨降低人工晶状体置换手术率的途径.方法 回顾总结40例人工晶状体置换术,分析手术原因,总结手术方法、并发症及预后.结果 行人工晶状体置换术的原因包括人工晶状体偏中心或脱位19例(47.5％),人工晶状体光学部术中损伤10例(25％),人工晶状体度数误差7例(17.5％),人工晶状体瞳孔夹持2例(5％),人工晶状体混浊1例(2.5％),多焦点人工晶状体植入术后眩光1例(2.5％).手术置换人工晶状体的方法包括人工晶状体囊袋内植入14例(35％),睫状沟植入14例(35％),巩膜缝线固定后房型人工晶状体11例(27.5％),前房型人工晶状体植入1例(2.5％).术后最佳矫正视力≥0.5者29例(72.5％),0.3～0.4者7例(17.5％),＜0.3者4例(10％).术后并发症包括散光7例(17.5％),黄斑囊样水肿2例(5％),轻度前房出血2例(5％).结论 人工晶状体置换术是治疗人工晶状体植入术后某些并发症的有效方法.应视眼部情况决定手术方法及选择再植入的人工晶状体.部分人工晶状体置换术是可以避免的,一期手术中合理的人工晶状体选择、精确的度数计算及顺利地植入是降低人工晶状体置换手术率的关键.

abstractsObjective To summarize the causes,surgical technique and effect of intraocular lens exchange surgery and analyze the change of the causes,and to explore the methods to decrease the surgical rate. Methods Forty cases (40 eyes) of lens exchange were retrospectively analyzed to get the causes and summarize the surgical technique,effects and prognosis. Results The causes included 19 cases (47.5％) with eccentric or dislocated intraocular lens (IOL),10 cases (25％) with damage to the optic part of IOL,7 cases (17.5％) with incorrect power,2 cases (5％) with iris capture,1 case (2.5％) with lens opacification and 1 case (2.5％) with postoperative glare.After extraction of the original implant,the second IOL was inserted in the lens bag in 14 cases (35％),in the ciliary sulcus in 14 cases (35％),in the anterior chamber in 1 case (2.5％) and with scleral fixation in 11cases (27.5％).The best corrected visual acuity over 0.5 was achieved in 29 cases (72.5％),0.3-0.4in 7 cases (17.5％),under 0.3 in 4 cases (10％).The surgical complications included astigmatism in 7 cases (17.5％),cystoid macular edema 2 cases (5％) and light hyphema 2 cases (5％). Conclusions Lens exchange is an effective way to manage some complications of lens implantation.The operative technique and selection of the second IOL rest on the ocular situation.Some lens exchange can be avoided.Proper IOL selection,accurate calculation and smoothly implantation in the original operation are the key points for the decrease of lens exchange rate.