摘要 目的 评价晶状体超声乳化玻璃体切割及后房型人工晶状体植入术的临床疗效。 方法 对16例患者行晶状体超声乳化玻璃体切割及后房型人工晶状体植入术。结果 3~1 0个月随访中,所有患者术后视力都有不同程度提高,视力0.5以上者6例(37.5%),0.2~ 0.4者7例(43.75%),0.1以下者3例(18.75%)。结论 玻璃体切割术中行晶状体超声乳 化术联合后房型人工晶状体植入术,能够获得良好视力而无严重并发症,是治疗白内障合并 眼后段病变一种较理想的手术。
Phacoemu lsification and posterior chamber intrao cular lens implantation
combined with p a rs plana vitrectomy
Hong Rongzhao Wu Hup ing Wang Jingqi Xiamen
(Ophthalmic Center ,Xiamen 361001)
Abstract ObjectiveTo inv estigate the the rapeutic effect on the patients undergon e phacoemulsification and posterior cham ber intraocular lens (IOL) implantation combined with pars plana vitrectomy (PPV ).MethodsCombined operation of phacoem u lsification and PPV were performed in 26 cases(16 eyes) with cataract complicate d by vitreoretinopathy.Primary indicatio ns for PPV included 8 cases of vitreous opacification,5 cases of retinal detachm ent,2 cases of intraocular foreign body, 1 case of macular hole,1 case of prolife rative diabetic retinopathy.ResultsVis u al acuity was improved in all cases.The follow-up period was 3~10 months.6 cases (37.5%) obtained visual acuities 0.5 or bet ter,7 cases(43.75%) had visual acuities bet ween 0.3~0.4,3 cases(18.75%)worse than 0.1.Po s toperative complications included cornea l edema in 3 cases,posterior capsular op acification in 2 cases,and recurrence of vitreous hemorrhage in 1 case.Conclusi onPhacoemulsification combined with IOL implantation can be performed during PPV .The patients obtain improvement in visu al acuity in the absence of servere comp lication,thus it is a promising method f or treating cataract in eyes with poster ior segment pathology.
Key words phacoem ulsification vitrectomy intraocular lens
玻璃体视网膜手术目前已成为治疗眼后节疾病的重要手段。临床上,当术眼晶状体混浊影响眼内手术操作时,常需联合晶状体手术(切除/超声乳化),称为晶状体玻璃体视网膜联合手术。传统方法是采用平坦部晶状体全部切除及玻璃体切割术,以解决屈光间质混浊。但手术后由于无晶状体囊膜支撑,致使人工晶状体植入困难,若保留前囊植入睫状沟式后房型人工晶状体,破坏了人工晶状体在囊袋内的完整性[1]。1997年1月至1997年12月,我们对16例(16只眼)患者进行晶状体超声乳化玻璃体切割及后房型人工晶状体植入术,现报道如下。
1 资料与方法
本组16例(16只眼)均存在显著影响视力的白内障,9例老年性白内障核硬度均在NⅢ以下,NⅢ以上者2例,晶状体半脱位并发白内障2例,外伤性白内障3例。男10例,女6例,年龄31~69岁(平均56岁)。术前视力:光感至手动2例,指数11例。0.2~0.09者3例,术前B型超声波检查显示玻璃体混浊,视网膜脱离,球内异物者经CT显示异物位于玻璃体腔,2例均为非磁性异物。术后随访3~10个月。行玻璃体视网膜手术的病因:玻璃体混浊8例,牵拉性视网膜脱离4例,球内异物2例,黄斑裂孔1例,增生性糖尿病视网膜病变1例。
手术方法 晶状体超声乳化基本方法同以往报道[2],其中巩膜隧道切口6例,颞侧透明切口10例,皮质吸除后用9/0尼龙线间断缝合1针。建立3通道扁平部玻璃体切割术,玻璃体切割后,检查视网膜情况,剥离视网膜前膜,恢复视网膜活动度,有裂孔者行眼内激光封闭。扩大角巩膜隧道口,有6例植入5mm×6mm单片PMMA椭圆形人工晶状体,有10例植入水凝胶折叠式人工晶状体,行气-液交换后关闭3切口。
2 结果
术后随访3~10个月期间内,所有患者术后视力都有不同程度提高,视力0.5以上者6例(37.5%),0.2~0.4者7例(43.75%),0.1以下者3例(18.75%)。本组所有患者在玻璃体手术中角膜保持透明,未见因超声乳化所致并发症。术后并发症包括角膜水肿4例,均在2~3天内消退,后期后囊混浊3例,均行Nd-YAG激光治疗。1例玻璃体再出血,未见其它并发症。
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