推荐回答(1个)
白内障人工晶体植入术后常见并发症有浅前房、上皮植入前房、持续角膜水肿、前房和玻璃体积血、葡萄膜炎、化脓性眼内炎、青光眼、人工晶体位置异常、后囊膜混浊、视网膜并发症等。
(1)浅前房可由下列原因引起:①切口渗漏。切口渗漏常由于不良缝合、玻璃体嵌顿于切口、高眼压等原因引起。②脉络膜脱离。浆液性的脉络膜脱离常见于术后低眼压、浅前房,在术后7~10天仍不恢复者,一般脱离部位多在下方。大部分脉络膜脱离属于继发性,常因切口渗漏、炎症所致。③瞳孔阻滞。人工晶体植入术后如果虹膜渗出或与人工晶体发生粘连,同时未进行虹膜周边切除或切除口不通畅时,可发生瞳孔阻滞,此时,房水不能到达前房而积聚于后房内,引起眼压升高、浅前房。
(2)持续角膜水肿(大泡性角膜病变)是人工晶体术后严重并发症,其原因可为:①术前已存在角膜内皮病变或已作过眼内手术,有明显的角膜内皮细胞损害;②手术中过度损伤,包括机械性损伤和较长时间、较大量前房冲洗液的使用;③玻璃体、人工晶体与角膜接触、粘连或嵌顿于切口;④角膜与眼内组织粘连;⑤上皮植入和纤维内生;⑥后弹力层撕脱;⑦
青光眼;⑧葡萄膜炎;⑨化学性损伤。
(3)前房和玻璃体积血:人工晶体植入术后的前房积血多发生于术后3~7天,积血大多数来源于切口被损伤的血管和虹膜血管,来源于睫状体血管者较少见。此种术后切口的出血多由于原来已收缩的血管重新张开或切口轻度移位导致脆弱的血管断裂。玻璃体积血常因糖尿病、视网膜裂孔或低眼压所致。玻璃体积血也可来源于睫状体或虹膜周边切除口。少量玻璃体积血沉于眼内下部,并不影响视力,因而很少引起注意,大量玻璃体积血可影响术后视力并可引起血影细胞性青光眼。
(4)上皮植入前房:上皮植入前房分为虹膜珍珠肿、虹膜囊肿及上皮植入前房三种。以虹膜囊肿多见,上皮植入前房则最为严重。这是由于手术时结膜、角膜等处上皮细胞植入或内生而形成的上皮囊肿,患眼常伴有切口愈合不良、前房形成迟缓、虹膜和晶状体物质及玻璃体等嵌入切口。植入的上皮与虹膜或血管组织接触而增殖。上皮堵塞房角引起继发性青光眼。
(5)葡萄膜炎:人工晶体植入术后严重的葡萄膜炎多伴随着一些术后并发症,如眼内出血、玻璃体脱出、晶状体皮质残留、上皮植入和视网膜脱离等。术后葡萄膜炎也可能由于严重的手术创伤、伤口有组织嵌顿、某些全身性疾病、交感性眼炎等原因引起。如果植入质量较差的人工晶体,而且人工晶体又经常与虹膜接触,可引起后房型人工晶体极少见的UGH综合征,即葡萄膜炎合并前房积血和继发性青光眼。
(6)化脓性眼内炎:眼内炎是人工晶体植入术后最严重的并发症。最常见的感染源为手术野,其次为术者的手、术中用的器械、抽吸灌注管道和冲洗液、术后用的眼药水和眼药膏,手术室的空气和空调机亦会成为感染源。
(7)青光眼:人工晶体植入术后一般有短暂眼压升高过程,无需特殊处理。持续性的眼压升高主要见于术前已存在的青光眼、晶状体皮质残留过多、长期大量应用皮质类固醇、炎症、瞳孔阻滞、玻璃体睫状环阻滞、虹膜前粘连、眼内出血、上皮植入和纤维内生等。
(8)人工晶体位置异常:①瞳孔夹持,这是指虹膜滑到人工晶状体的光学面的后面,多发生于植入位置接近虹膜的人工晶状体。其成因尚不清楚,但术后瞳孔阻滞、切口渗漏、拱形的人工晶体及囊膜与虹膜间的粘连可以使人工晶体边缘突入瞳孔平面,诱发瞳孔夹持。人工晶体襻一个在囊袋内,一个在睫状沟亦易引起瞳孔夹持。此外,手术后早期持续强力药物散大瞳孔也是产生瞳孔夹持的一个因素。②“日落”综合征,指因下方悬韧带断裂或广泛的后囊膜破裂而使后房型人工晶体脱位进入玻璃腔,在上方瞳孔区可见人工晶体光学面的赤道部。③“日出”综合征,指人工晶体向上移位,其较大部分位于上方虹膜后,光学面的下缘可在瞳孔区见到。这主要由于人工晶体上襻不在囊袋内,而支撑人工晶体下襻的囊袋发生粘连收缩所致。④“挡风玻璃刮水器”综合征,指植入睫状沟的人工晶体太短,不能良好的在其内固定,人工晶体象钟摆样摆动。
(9)后囊膜混浊:后囊膜混浊是白内障囊外摘出术后常见的晚期并发症,术后3~5年内约有50%的成人发生此证,而儿童则无一幸免。这是由于赤道部残留的晶体上皮细胞沿着后囊膜广泛地移行、增殖所致。
(10)视网膜并发症:主要是黄斑囊样水肿和视网膜脱离。其病因不明,可能与炎症及玻璃体条索牵拉有关
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