探讨晶状体脱位患者术中隐匿性周边视网膜病变的检出特征及评价睫状体平坦部玻璃体切除术(PPV)的治疗效果。

选取2024年4月至2025年4月于首都医科大学附属北京同仁医院眼外伤科接受手术治疗的晶状体脱位患者60例(60只眼)作为研究对象。其中，男性50例(50只眼)，女性10例(10只眼)；年龄29~77岁，平均年龄(58.0±9.0)岁。所有病例均建立25 G经巩膜三通道，依据晶状体脱位程度、囊袋支持情况及晶状体核硬度分别行晶状体超声乳化摘除联合前段玻璃体切除，或晶状体切除联合次全或全玻璃体切除，并于术中行360°巩膜顶压下周边视网膜检查。记录术前及术后裸眼视力、眼压、术中隐匿性周边视网膜病变类型及相应处理措施。年龄、裸眼视力及眼压等计量资料均先采用Shapiro-Wilk检验进行正态性检验，符合正态分布采用±s描述，术前术后比较采用配对t检验。性别、脱位原因、脱位程度、前房玻璃体疝及术中隐匿性周边视网膜病变检出情况等计数资料采用例数(眼数)和百分比描述，组间比较采用Pearson χ²检验。采用单因素Logistic回归分析术中隐匿性周边视网膜病变检出的相关因素。将单因素分析有差异的变量纳入多因素二元Logistic回归模型，筛选影响病变发生的独立相关因素。

所有患者中，14例(14只眼)行晶状体超声乳化摘除联合前段玻璃体切除，46例(46只眼)行晶状体切除联合次全或全玻璃体切除，分别占23.3%和76.7%。术中隐匿性周边视网膜病变检出32只眼，总检出率为53.3%。其中，视网膜裂孔、周边视网膜变性、锯齿缘离断及局限性视网膜浅脱离者分别为7例(7只眼)、21例(21只眼)、2例(2只眼)及2例(2只眼)，分别占11.7%、35.0%、3.3%及3.3%。术中行视网膜激光光凝和玻璃体腔空气填充分别为44例(44只眼)和8例(8只眼)，分别占73.3%和13.3%。人工晶状体囊袋内植入联合囊袋张力环植入、人工晶状体巩膜层间固定、睫状沟缝线固定及一期未植入人工晶状体者分别为14例(14只眼)、14例(35只眼)、14例(8只眼)及14例(3只眼)，分别占23.3%、58.3%、13.3%及5.0%。术前和术后裸眼视力分别为(1.55±0.54)最小分辨角对数(logMAR)和(0.87±0.73)logMAR，差异有统计学意义(t＝7.215，P<0.05)；术前和术后眼压分别为(17.6±6.8)mmHg(1 mmHg＝0.133 kPa)和(13.8±3.9)mmHg，差异有统计学意义(t＝5.102，P<0.05)。经多因素Logistic回归分析，年龄≥60岁、外伤性晶状体脱位及晶状体全脱位为隐匿性周边视网膜病变的独立危险因素(OR＝3.197，4.158，3.334，95%CI: 1.001~10.212，1.182~14.617，1.005~11.067；P<0.05)。

晶状体脱位患者术中可检出较高比例的术前未识别的周边视网膜病变，提示常规术前检查可能低估后段风险。对于年龄较大、外伤性脱位、全脱位及术前眼底显示受限的患者，应重视术中360°周边视网膜检查。术中系统探查可帮助及时发现并处理视网膜裂孔、锯齿缘离断、局限性视网膜浅脱离及高危周边变性，可能有助于降低术后视网膜并发症风险。

The aim of this study is to investigate the intraoperative detection characteristics of occult peripheral retinal lesions and clinical treatment effects of pars plana vitrectomy (PPV) in patients with lens dislocation.

A total of 60 patients, 60 eyes, with lens dislocation who underwent surgical treatment in the Department of Ocular Trauma, Beijing Tongren Hospital Affiliated with Capital Medical University, from April 2024 to April 2025 were collected. Among them, 50 patients (50 eyes), were male and 10 patients (10 eyes), were female. The patients were 29 to 77 years old, with a mean age of 58.0±9.0 years. A 25 G transscleral three-port approach was established in all cases. According to the extent of lens dislocation, capsular support, and lens nucleus hardness, phacoemulsification combined with anterior vitrectomy or lensectomy combined with subtotal or complete vitrectomy was performed. Intraoperative 360° peripheral retinal examination with scleral indentation was performed in all eyes. Preoperative and postoperative uncorrected visual acuity, intraocular pressure, types of occult peripheral retinal lesions, and corresponding intraoperative management were recorded. For measurement data including age, uncorrected visual acuity and intraocular pressure, normality was assessed using the Shapiro-Wilk test. Normally distributed continuous variables were expressed as ±s, and preoperative and postoperative values were compared using the paired t-test. Categorical variables such as gender, lens dislocation cause, dislocation degree and presence of anterior chamber vitreous prolapse as well as detection status of intraoperative occult peripheral retinal lesions were expressed as cases (eyes) and percentages, and Pearson chi-square test was used for intergroup comparison. Univariate Logistic regression analysis was performed to identify factors associated with the detection of occult peripheral retinal lesions. Significant variables were incorporated into the multivariate binary Logistic regression model to screen independent risk factors for the occurrence of the lesions.

Among the 60 eyes, 14 cases (14 eyes), 23.3%, underwent phacoemulsification combined with anterior vitrectomy, and 46 cases (46 eyes), 76.7%, underwent lensectomy combined with subtotal or complete vitrectomy. Occult peripheral retinal lesions were detected in 32 cases (32 eyes), 53.3%, including retinal breaks in 7cases (7 eyes), 11.7%, peripheral retinal degeneration in 21 cases (21 eyes), 35.0%, ora serrata dialysis in 2 cases (2 eyes), 3.3%, and localized shallow retinal detachment in 2 cases (2 eyes), 3.3%. Intraoperative retinal photocoagulation was performed in 44 cases (44 eyes), 73.3%, and intravitreal air tamponade was performed in 8 cases (8 eyes), 13.3%. In-the-bag intraocular lens implantation combined with capsular tension ring implantation was performed in 14 cases (14 eyes), 23.3%; intrascleral intraocular lens fixation was performed in 35 cases (35 eyes), 58.3%; ciliary sulcus suture fixation was performed in 8 cases (8 eyes), 13.3%; and 3 cases (3 eyes), 5.0%, were left aphakic. The preoperative uncorrected visual acuity was (1.55±0.54) logMAR, and the postoperative uncorrected visual acuity was (0.87±0.73) logMAR. The difference was statistically significant (t=7.215, P<0.05). The preoperative intraocular pressure was (17.6±6.8) mmHg (1 mmHg=0.133 kPa), and the postoperative intraocular pressure was (13.8±3.9) mmHg. The difference was statistically significant (t=5.102, P<0.05). Multivariate binary Logistic regression analysis showed that age ≥60 years, traumatic lens dislocation and complete lens dislocation were independent risk factors for occult peripheral retinal lesions (OR=3.197, 4.158, 3.334, 95%CI: 1.001 to 10.212, 1.182 to 14.617, 1.005 to 11.067; P<0.05).

A relatively high proportion of occult peripheral retinal lesions can be detected intraoperatively in patients with lens dislocation, suggesting that routine preoperative examination may underestimate posterior segment risk. Intraoperative 360° peripheral retinal examination should be emphasized, particularly in older patients and those with traumatic lens dislocation, complete lens dislocation, or limited preoperative fundus visualization. Systematic intraoperative exploration with scleral indentation can facilitate timely detection and management of retinal breaks, ora serrata dialysis, localized shallow retinal detachment, and high-risk peripheral retinal degeneration, and may help reduce the risk of postoperative retinal complications.