摘要　目的　比较白内障囊外摘出及后房型人工晶状体植入术中2种不同的截囊方法的术后效果。方法　将70例患者随机分为A、B 2组，A组38例41眼，采用开罐式截囊后房型人工晶状体植入术，B组32例37眼采用信封式截囊囊袋内人工晶状体植入术。随访3mo～2a，比较2组视力恢复情况和并发症。结果　术后1d视力≥0.1者，A组70.7%，B组81%，术后3mo～2a视力≥0.5者，A组90.24%，B组94.6%，2组比较无显著性差异(P＞0.05)。A、B 2组并发症发生率分别为53.6%和13.5%组比较有显著性差异(P＜0.01)。结论　信封式截囊囊袋内植入人工晶状体优于开罐式截囊后房型人工晶状体植入。

Comparison of the effects of two kinds of capsulectomy of the operation of posterior chamber intrao cular lens implantation

　　LIU Xiao-Hong, LI Hui-Qin

　　Abstract　Objective　To compare the effects of two kinds of capsulectomy of the operation of extracapsule cataract extraction and posterior chamber intraocular lens implantation.Methods　Of 70 cases of cataract,78 eyes were divided into two groups randomly:group A and group B.In the group A,38 cases(41 eyes),opener anterior capsulectomy was used and posterior chamber intraocular lenes was implanted.In the group B,32 cases(37 eyes),D-shaped anterior capsulectomy was used and lenes was implanted into the capsule bag.Follow up time was from three months to two years.Post-operative vision and the complications of the operation of the two groups were evaluated.Results　One day after the operation,70.70% of the eyes in the group A got a visual acuity at 0.1 or better.But group B was 81%.After the operation patients were followed up for 3 to 24 months.In the group A,37 eyes (90.24%) got a visual acuity at 0.5 or better,In the group B there were 35 eyes(94.60%).It showed no significant difference(P＞0.5).In the group B that complications of the operation were 13.5% whereas that 53.6% in the group A.That the complications of the operation in group B was less than group A (P＜0.01).Conclusion　D-shaped capsulectomy and lens implanting into the capsule bag was better than opener anterior capsulectomy and lens implanting in the posterior chamber.

　　Key words　intraocular lens implantation;capsulectomy;cataract

　　晶状体前囊膜的切除是现代白内障囊外摘出及后房型人工晶状体植入术的重要步骤和主要关键技术之一^［1］，目前常用的截囊方法有以下几种：开罐式、连续环形撕囊法、开信封式、邮票式。这几种截囊法各有其优缺点，因此选择较好的截囊方式是保证人工晶状体植入囊袋内的重要因素，我们自1994年10月～1997年2月间，分别用开罐式截囊后房型人工晶状体植入及信封式截囊囊袋内人工晶状体植入术治疗70例白内障患者，现将结果报告如下。

　　1　资料和方法

　　1.1　一般资料　70例(78眼)白内障患者，男38例41眼，女32例37眼；年龄14～85a，平均56.5a，随机分为A、B 2组。A组36例41眼，采用开罐截囊，B组34例(37眼)采用信封式截囊。

　　1.2　手术方法　全部病例均在局麻下进行，按常规显微手术操作，所有病例均做以穹窿为基底的结膜瓣，于上方10～2点角巩膜缘行板层切开后，再于12点位穿刺进入前房，准备截囊。

　　1.2.1　开罐式截囊　用剃须刀片于12点位穿刺前房后用号注射针头自制成截囊针，从7点位开始，顺时针方向依次点状或小三角形撕裂后，最后连接成一个大中央开口，然后挽出晶状体核，冲洗出晶状体皮质，植入后房型人工晶状体。

　　1.2.2　信封式截囊　于12点位穿刺入前房后，用自制的截囊针进入前房后，从10～2点将前囊膜呈线状切开，用冲洗针头向前囊下注水少许，分离前囊与晶状体核，并轻轻拨动晶状体核，然后扩大角巩膜缘切口，用压迫法挽出晶状体核，在囊袋内用BSS液灌注，吸出晶状体皮质，再于前囊下囊袋内注入粘弹剂，植入后房型人工晶状体，缝合12点位角巩膜切口后，于人工晶状体表面及前房注入少许粘弹剂以加深前房，并使前囊膜与人工晶状体分开一段距离，伸入囊膜剪于前囊上方线形切口两端垂直向下剪开，使前囊膜呈“U”形，将撕囊镊伸进前房，夹住切口一侧囊膜，撕脱并拉出之，再缝合角巩膜缘切口，并冲洗前房内粘弹剂即可。

　　2　结果

　　2.1　术后视力　术后1d的视力：A组≥0.1者29眼，占70.7%；B组≥0.1者30眼占81%.术后3mo视力：≥0.5者A组90.24%；B组94.6%，2组比较P＞0.05，无显著性差异(见表1)。

表1　2组术后随访视力比较

　　Table 1　Comparison of visual acuity postoperative in the two groups

　　2.2　手术并发症　术中囊膜破裂、玻璃体脱出，术后葡萄膜炎、角膜水肿等并发症A组共有22眼，占53.6%，B组5眼，占13.5%，2组并发症眼数比较χ²=13.85，P＜0.01，有显著性差异(见表2)。

表2　2组手术并发症比较

　　Table 2　Surgical complications in the two groups

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