中华眼科杂志 1999年第2期第35卷 白内障
作者:王文清 杨冠 宁文捷 方健
单位:200233 上海市第六人民医院眼科
关键词:白内障摘除术;瞳孔
【摘要】 目的 探讨小瞳孔状态下超声乳化的手术技巧和注意事项。方法 应用非切开瞳孔牵拉扩张法及原位超声乳化碎核等技术对77例(83只眼)小瞳孔白内障行超声乳化。结果 83只眼中66只眼应用单纯非切开瞳孔牵拉扩张法,术后全部瞳孔恢复原状;17只眼分离粘连机化膜剪除后再牵拉扩张,术后15只眼基本恢复圆瞳孔,2只眼瞳孔不规则。术后1个月裸眼视力≥0.5者46只眼(55.4%),矫正视力≥0.5者71只眼(85.5%)。结论 非切开瞳孔牵拉扩张法可使小瞳孔白内障术后恢复生理性圆瞳孔,无不良反应。
Phacoemulsification through a small pupil WANG Wenqing, yANG Guan, NING Wenjie, et al. Department of Ophthalmology, Shanghai Sixth people′s Hospital, Shanghai 200233
【Abstract】 Objective To discuss the surgical techniques and attention points in phacoemulsification through a small pupil. method Eighty three cataracts of 77 patients were emulsified by using non-cut pupil dilation, cystotome or diathermic high-frequency capsulorrhexis.Results The66 cataracts of 83 eyes were emulsified by means of the above method. After the surgery, all the pupils were recovered to normal size (2 to 3 mm), and none of them were damaged. In 17 eyes, the procedure was performed after separation of synechia and excision of the organized membranes; after the surgery, a round pupil was obtained in 15 cases and an irregular pupil in 2 cases. The visual acuity at postoperative 1 month was ≥0.5 in 46 eyes (55.4%) and corrected≥0.5 in 71 eyes (85.5%). Conclusion After phacoemulsification through a small pupil by non-cut pupil dilation method, the pupil can be recovered to normal and no unfavorable reaction is seen.
【Key words】 Cataract extraction Pupil
小瞳孔状态给白内障超声乳化手术带来诸多困难,处理不当容易产生众多并发症和不良后果。为探讨此类手术技巧及注意事项,现将我院白内障超声乳化中心1485例手术中瞳孔小于4mm以下的77例(83只眼)手术情况,介绍如下。
资料和方法
1.临床资料:共收集77例(83只眼)白内障患者,女39例(43只眼);男38例(40只眼)。年龄40~88岁,平均74.2岁。全部患者除一例为外伤性白内障外,余均为老年性或并发性白内障;其中伴高度近视(≥10.00 d)9只眼,伴糖尿病25只眼;抗青光眼术后12只眼,陈旧性虹膜睫状体炎7只眼(其中3只眼瞳孔膜闭),40只眼为老年性瞳孔强直征。根据LOCSⅡ核分级法将晶体分级,其中Ⅱ级核11只眼,Ⅲ级核55只眼,Ⅳ级核10只眼,Ⅴ级7只眼。使用美国Sonomed公司生产的A、B超声仪测量眼轴长和了解眼底状况;选用瑞典Pharmacia公司生产和美国Allergan公司生产的一体型人工晶体,光学部直径为5.5 mm,总长度为12.5 mm。
2.手术方法:常规球周麻醉,软化眼球,做角巩缘后2mm反眉弓隧道式自闭切口,弧长5.5 mm,穿刺后前房注入足量粘弹剂。对2~4mm轻度后粘连或无粘连瞳孔,用虹膜钩或分叉调节杆两个器械相互反方向多次牵拉扩张瞳孔,直至瞳孔伸展约5~6 mm;而对于2 mm以下广泛后粘连或闭锁瞳孔,先用囊膜剪刀剪开粘连,然后剪去或撕去机化膜片,再做牵拉扩张瞳孔约5 mm;用截囊针或瑞士Oertli公司生产的高频电子透热撕囊仪做5 mm环形撕囊,充分水力分离核与皮质后行原位超声乳化碎核吸出(采用瑞士Oertli公司生产的Qinto型超声乳化仪,45°探针,能量设定为50%~70%,负压吸引为50~80 mm Hg),(1 mm Hg=0.133 kPa,蠕动泵),清除残余皮质,再次前房注入粘弹剂,囊袋内植入人工晶体,10-0尼龙线缝合伤口1针。
3.超声能量和乳化时间:Ⅱ级核11只眼,设定能量为50%,乳化时间33~36 s,平均42.8 s;Ⅲ级核55只眼,设定能量为50%~55%,乳化时间53~137s,平均91.2 s;Ⅳ~Ⅴ级核17只眼,设定能量为60%~70%,乳化时间75~164s,平均128.9s。
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