人工晶状体在人工晶体眼中混浊的临床实例：微观结构研究结果分析

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重要性. 现如今，全世界白内障手术中植入了大量不同材质的人工晶状体（intraocular lens，IOL）。随着现代IOL材料和设计的发展，出现了关于IOL混浊的报导。IOL混浊的部位和特点主要取决于材料属性。目前，聚甲基丙烯酸甲酯较少用于制作IOL，常常由于结构损坏导致光学中心变混浊，形成“雪花状”裂纹。丙烯酸酯IOL浑浊取决于材料的亲水程度。通常，亲水性丙烯酸酯IOL视光区因结晶物沉积导致视力明显下降且需要将其取出。亲水性丙烯酸酯IOL发生混浊取决于患者的伴随疾病。疏水性丙烯酸酯IOL中形成液泡，并发生“闪光”现象。此外，视功能通常不受影响。

目的. 找出IOL哪些结构改变导致视力下降进而必须从人工晶体眼中取出。

材料和方法. 研究了4种不同材质混浊的IOL。通过使用扫描电子显微镜SUPRA 55VP（Carl Zeiss,德国）和二次电子检测器对IOL进行了研究。使用Xmax 80mm2能量色散X射线分析检测器（英国，牛津）收集IOL表面和内部的元素分布图。

结果. 人工晶体植入5年后，带有疏水涂层的亲水性IOL已经变混浊。在IOL表面的所有部位发现了羟基磷灰石晶体。在疏水丙烯酸酯IOL中，通过扫描电子显微镜确定了视觉中心有微小液泡和腔。2个聚甲基丙烯酸甲酯IOL在植入8年后，自身结构被破坏。此类IOL的化学分析中未发现任何无机化合物。

结论. 植入IOL并发症之一是丧失其透明性。导致术后不同时期晶状体变混浊可能与人工晶状体的材料和制造有关，也可能与患者的伴随疾病有关。

作者简介

Inna Riks

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Email: riks0503@yandex.ru
SPIN 代码: 4297-6543

МD, PhD, Assistant, Ophthalmology Department

俄罗斯联邦, Saint Petersburg

Sergey Astakhov

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Email: astakhov73@mail.ru
SPIN 代码: 7732-1150

МD, PhD, DMedSc, Professor, Head, Ophthalmology Department

俄罗斯联邦, Saint Petersburg

Elena Ivankova

Institute of Macromolecular Compounds Russian Academy of Sciences

Email: ivelen@mail.ru

PhD, Senior Researcher

俄罗斯联邦, Saint Petersburg

Irina Kuzmina

Academican I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: Kuzmina.irina07@mail.ru

МD, Ophthalmologist, Ophthalmology Department

俄罗斯联邦, Saint Petersburg

Sanasar Papanyan

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

编辑信件的主要联系方式.
Email: Dr.papanyan@yandex.ru
ORCID iD: 0000-0003-3766-2211
SPIN 代码: 9794-4692

МD, PhD, Ophtalmologist, Ophthalmology Department

俄罗斯联邦, Saint Petersburg

Rafik Boutaba

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russia

Email: boutabarafik@yahoo.fr

МD, Clinical Resident, Ophthalmology Department

俄罗斯联邦, Saint-Petersburg

Maggie Ezugbaya

Academican I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: Maggie-92@mail.ru

МD, Postgraduate Research student, Ophthalmology Department

俄罗斯联邦, Saint Petersburg

Evgeni Akopov

Academican I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: elacop@mail.ru

МD, PhD, Assistant Professor, Ophthalmology Department

俄罗斯联邦, Saint Petersburg

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