眼视光学杂志 2000年第4期第2卷 经验交流
作者：赵云娥 王勤美 徐明 秦要武
单位：温州医学院附属眼视光医院，浙江 温州 325027
关键词：白内障；外科学；连续环形撕囊；超乳；蚀刻；劈核
［摘 要］ 目的:探讨成熟期白内障超声乳化手术前囊连续环形撕囊及晶状体核乳化的操作方式、注意点及术中应变技巧。方法:对成熟期白内障50眼作前囊连续环形撕囊，采用蚀刻法与劈核法相结合，核块以脉冲方式在囊袋内或囊膜上后房内乳化。 结果:50眼前囊连续环形撕囊一次成功24例；吸除部分皮质后撕囊成功18例；出现放射状撕裂，以剪刀剪出一囊膜瓣再撕囊8例。术中出现后囊破裂5例，乳化头损伤虹膜1例。术后二月裸眼视力1.0及以上26例，0.5～0.8者18例，0.2～0.4者6例。结论：成熟期白内障超乳手术中前囊连续环形撕囊是手术成功的关键，但如出现囊膜放射状撕裂仍可小心地完成核乳化，术中熟练运用劈核法降低超声能量，可减轻术中损伤、术后炎症反应。
［中图分类号］ R776.1 ［文献标识码］ B
［文章编号］ 1008-1801(2000)04-0232-02
Phacoemulsification of 50 cases with white cataract
ZHAO Yun-e,WANG Qin-mei，XU Ming，et al.
(The Optometry Eye Hospital of Wenzhou Medical College, Wenzhou 325027)
Abstract： Objective：To analyze the method of continuous circular capsulorhexis(CCC) and nucleus phacoemulsification in white cataract cases.Methods：50 cases of white cataract were included, CCC were done, then nucleus were phacoed with sclupt and chop technique endocapsular or superacapsular. Small pieces were phacoed under pulse energy.Results：CCC were primarily done successfully in 24 cases, then CCC done successfully after cortex were removed in 18 cases, CCC were finished after making a flap when radial tear occurred in 8 cases. Posterior capsular rupture were occurred in 5 cases, iris trauma in 1 case. Visual acuity were 20/20 or better in 26 cases in 2 months, 20/40 to 20/25 in 18 cases, 20/100 to 20/50 in 6 cases.Conclusion：A successful CCC is important in white cataract during phacoemulsification. If there is radial tear occurred in anterior capsular, emulsification still can be done carefully. Using stop and chop technique could decrease phaco power, then decrease ocular trauma during surgery and possible inflammation after surgery.
Key words： cataract/surgery; continuous circular capsulorhexis; phacoemulsification; sclupt and chop technique
超声乳化手术作为治疗白内障的一种较新手术方式，由于手术损伤小、术后恢复快，已越来越广泛地为医师和患者所接受。但临床上常遇到成熟期白内障，皮质呈白色或轻度乳化，此类病例由于术中不能透见眼底红光反射，前囊和核的处理都有一定难度。笔者收集本院1999年3月～8月间作超声乳化手术的50例50眼成熟期白内障，总结报告如下。
1 资料和方法
1.1 对象 50例50眼，男22例，女28例，年龄52～89岁，其中2例为青光眼术后，有部分虹膜后粘连，2例挫伤性白内障，余46例为老年性白内障。晶状体核分级［1］，Ⅱ级8例，Ⅲ级22例，Ⅳ级20例。
1.2 手术方法 手术在局麻下进行，作上方或颞侧巩膜隧道切口，3点或6点钟作辅助切口，前房注入粘弹剂，环形撕前囊，乳化吸出晶状体核，吸除残余皮质，植入人工晶状体于囊袋内，恢复结膜。
撕囊：注入粘弹剂压平前囊膜，以4号半自制截囊针在中部钩起一三角形瓣，以撕囊镊完成撕囊，直径5～6mm;如出现放射状撕裂，以剪刀剪出一囊膜瓣再撕囊。
轻柔作水分离使核能转动。连续方式乳化出第一个沟槽后，将核分为两半，转动90度，乳化头置于核块中央部，辅手钩伸入核的周边部并拉向中央劈成小块，以脉冲方式逐块乳化。在核块较薄时，以辅手钩轻微向后压后囊膜，避免被乳化头误吸损伤。
大部分病例核的乳化在囊袋内完成，小部分由于囊袋放射状裂口，乳化前一边注入粘弹剂于核后方将核脱出囊袋外，再压回虹膜后即囊袋上后房内进行乳化，方法同上。
由于手术用超乳仪不同，手术参数分为二组。一组为Geuder超乳仪，Ⅱ级核8眼，时间38s～1min 8s，平均53.25s；Ⅲ级核14眼,时间1min 2s～3min，平均1min35s；Ⅳ级核10眼，时间2min 18s～3min 55s，平均3min 8s。另一组为Storz组，Ⅲ级核8眼，能量20%～36%，平均26%，时间2min 52s～3min 27s，平均3min 5s；Ⅳ级核10眼，能量20%～45%，平均31%，时间3min 57s～4min 38s,平均4min 8s。
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