【摘要】 目的 观察表麻下小切口非超声乳化白内障手术术中、术后并发症,对其进行分析并提出处理意见。方法 96例(125眼)白内障,表面麻醉下进行小切口非超声乳化白内障摘除并人工晶体植入术。结果 术中:虹膜脱出13眼,晶状体后囊破裂9眼。术后:角膜内皮条样浑浊29眼,片状浑浊10眼,前房纤维素样渗出7眼。结论 表麻下小切口非超声乳化白内障手术避免了球周、球后麻醉带来的一系列并发症。对晶状体核的处理较关键,亦是易产生并发症的步骤。
【关键词】 表面麻醉;小切口;非超声乳化白内障摘除;并发症
Complication in small incisioin non-phacoemulsification cataract surgery with topical anesthesia
ZHANG Chunjie,ZHANG Fengxia,CAO Hui.Department of Ophthalmology,Central Hospital of Feicheng Mining Group Co.Ltd,Shandong 271608,China
【Abstract】 Objective To observe the complications caused by small incision non-phacoemulsification cataract operation with topical anesthesia,analyze the results and give some advice about the disposal. Methods 96 patients（125 eyes） were observed. After topical anesthesia,cataract extraction with IOL implantation in small incision were going on based on chop technique with lens loop pad. Results Intraoperative complications included iris prolapse in 13 eyes,posterior capsule rupture in 9 eyes,and some postoperative complications,including 29 strip shaped opacity in corneal endothelium,10 sheet shaped opacity in cornea endothelium,7 anterior chamber fribrinous exudates.Conclusion A lot of complications what caused by retrobulbar anesthesia and peribulbar anesthesia can be avoid with topical anesthesia in small non-phacoemulsification cataract surgery. It is very important to treat the lens nucleus accurately and this procedure would be more likely to bring on complications.
【Key words】 topical anesthesia;small incision;nonphacoemulsification cataract extraction;complication
小切口非超声乳化白内障手术由于手术并发症少，术后视力恢复好,所需费用低廉,疗效可靠,临床已有较多报道［1～3］，现将我院近1年来所做的125眼手术疗效及并发症进行探讨如下。
1 资料与方法
1.1 一般资料 住院白内障患者96例（125眼）,男52例(67眼),女44例(58眼),年龄15～82岁;其中并发性白内障27眼,外伤性白内障19眼,老年性白内障79眼。
1.2 手术方法 全部病例均在手术显微镜下操作,术前30min给予美多丽散瞳，倍诺喜眼药水表面麻醉，开睑器开睑,少数不合作病人做上直肌牵引缝线,11点～1点作以穹隆为基底的结膜瓣,烧灼器烧灼止血,距角膜缘后界1mm水平或反眉状1/2板层切开巩膜，切口长约5.5mm,作巩膜隧道入透明角膜1.5mm,前房内注入黏弹剂，自制截囊针环形撕囊或截囊,水分离晶状体核,转动晶状体核并使其上方赤道部翘入前房，晶状体核上下均注入黏弹剂,用晶状体套匙托出晶状体核，双套管注吸器吸净皮质,前房及囊袋内注入黏弹剂，植入人工晶体于囊袋内或睫状沟。仅对虹膜反复脱出及玻璃体大量脱出者巩膜切口缝合1针,一般不需缝合,整复球结膜瓣,球结膜下注射庆大霉素2万u加地塞米松2.5mg，无菌纱布包扎术眼，术后1天换药。
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