［摘要］ 目的 分析白内障超声乳化吸除联合人工晶体植入术治疗高度近视伴严重视网膜脉络膜病变的白内障患者的疗效。方法 对63例（63眼）高度近视伴严重视网膜脉络膜病变的白内障患者行巩膜隧道切口超声乳化白内障吸除联合人工晶体植入术,平均年龄68岁,术前矫正视力光感~0.1,平均近视度数-12.4 D,平均植入人工晶体度数+2.77 D。结果 除1眼术后视力未提高外,其余眼术后视力均有不同程度提高,术后视力≥0.1者占74.6%,≥0.3者占27%,未见视网膜裂孔和视网膜脱离等并发症。结论 超声乳化白内障吸除联合人工晶体植入术可在一定程度上提高高度近视伴严重视网膜脉络膜病变的白内障患者的视力,提高患者的生活质量,术中切忌追求速度和操作粗暴。
［关键词］ 高度近视；白内障；视网膜脉络膜病变
Effectiveness of cataract extraction with phacoemulsification and implantation of PCLOL to treat high myopianion serious chorioretinopathy
TAO Yanting,JIA Wenbo.Department of Ophthalmology,Shanghai Harbour Hospital,Shanghai 200125,China
［Abstract］ Objective To analyse the effectiveness of cataract extraction with phacoemulsification and implantation of posterior chamber intraocular lens to treat high myopia complicated serious chorioretinopathy.Methods Phacoemulsification and implantation of PCLOL through sclera tunnel incison was performed on 63 high myopia patients with cataract complicated serious chorioretinopathy.The average age of patients was 68 years(48~86) old.The preoperative corrected visual acuity was LP~0.1.The mean diopter was -12.4 D.The mean diopter of LOL was +2.77 D.Results Except that visual has not been improved after one surgery,visual improve in various degree.The visual acuity of 0.1 over better was obtained in 74.6%.0.3 or better obtained in 27%.No retinal hove or detachment were observed.Conclusion The visual of high myopia patients with cataract complicated serious chorioretinopathy can be improved in various degree by phacoemulsification and implantation of PCLOL,and improved the quality of patients’ life.Must taboo pursuing the speed and operating rudly in the surgery.
［Key words］ high myopia;cataract;chorioretinopathy
目前超声乳化白内障吸除联合人工晶体植入术正占据白内障摘除手术的主导地位。然而,对于高度近视眼伴严重视网膜脉络膜病变的白内障患者来说,其白内障手术的疗效目前尚有顾虑。本文对2002年1月~2004年5月在我院行白内障摘除手术且合并高度近视伴严重视网膜脉络膜病变患者63例的手术效果进行回顾性研究,现将结果报告如下。
1 资料与方法
1.1 一般资料 收集2002年1月~2004年5月在我院行白内障摘除术且合并高度近视伴严重视网膜脉络膜病变患者63例（63眼）,男15例（15眼）,女48例（48眼）,年龄48~86岁,平均68岁,均于术后眼底检查明确有严重视网膜脉络膜病变。术前矫正视力：光感~眼前和一尺指数者48眼（85.7%）,0.01~0.08者8眼（14.3%）；<0.1者62眼（98.4%）,0.1者1眼（1.6%）。核硬度:Ⅱ级16眼（25.4%）,Ⅲ级31眼（49.2%）,Ⅳ级16眼（25.4%）。术前近视度数-8.0 D~-23.0 D,平均-12.4 D；以SPK/Ⅱ公式计算人工晶体屈光度数,最后术中植入人工晶体屈光度数-5.0 D~+14.5 D,平均+2.77 D。术后随访12个月。
1.2 仪器和设备 采用Alcon公司Universal Ⅱ型超声乳化仪,Alcon公司OcuscanA/B型超声检测仪。Topcon公司OMS-85手术显微镜。
1.3 手术方法 术前30 min开始用美多丽滴眼液散瞳,术前10 min术眼滴1次爱尔凯因眼药水（0.5%盐酸丙美卡因）进行表面麻醉,于上方角巩膜缘后2 mm作巩膜隧道切口,前房内注入黏弹剂,连续环形撕囊,直径5.5 mm,充分水分离,囊袋内原位劈核超声乳化,超声能量60%,所用时间30~110 s,植入PMMA 5.5 mm直径人工晶体,吸除残留的黏弹剂,巩膜切口不缝合。
2 结果
2.1 手术情况 手术均顺利完成,且成功植入人工晶体,手术时间均小于15 min。
2.2 术后最佳矫正视力 眼前和一尺指数者1眼（1.6%）,0.01~0.08者15眼（23.8%）,0.1~0.2者30眼（47.6%）,0.3~0.6者17眼（27.0%）,除1眼术后视力无提高外,其余术眼视力均较术前有不同程度提高。
2.3 并发症 术中发生后囊膜破裂3例,破口小,无玻璃体脱出,均囊袋内植入人工晶体。术后有21眼发生角膜水肿,经局部药物处理,3~5天内全部消失,所有病例术后未发生视网膜裂孔、视网膜脱离以及其他并发症。
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