【摘要】 目的：探讨高度近视眼合并白内障行超声乳化白内障吸除人工晶状体植入术治疗的临床疗效。 方法：27例（37眼）因白内障合并高度近视行超声乳化白内障吸除+人工晶状体植入术。记录术前眼轴长度和术后视力，屈光度数，观察手术并发症术后眼部情况。术后随访时间为6～24mo。结果：术前平均眼轴长度为28.3mm。术后最佳矫正视力≥0．2共35眼(95％)，≥0．5者共33眼(89％)。术中无后囊膜破裂；术后角膜水肿2眼，术后一过性高眼压1眼，后发性白内障2眼；术后发现黄斑变性和眼底出血共4例，无视网膜和脉络膜脱离者。 结论：超声乳化白内障吸除低度数折叠式人工晶状体植入术是治疗白内障合并高度近视眼安全、有效的方法。
【关键词】 超声乳化白内障吸除术；晶状体植入；高度近视；并发症
Cataract phacoemulsification combined intraocular lens implantation in 27 high myopia cases
YouLi Huang, Xu Huang, LiJun Zhou, XiaoMei Meng
Department of Ophthalmology, the Second Peoples Hospital, Wuxi 214002, Jiangsu Province, China
AbstractAIM: To evaluate the clinical effect of phacoemulsification and IOL implantation for cataract with high myopia.
METHODS: Twentyseven cases (37 eyes) of cataract with high myopia accepted phacoemulsification and IOL implantation. Preoperative axial length, postoperative visual acuity and refractive error were recorded. Intraoperative and postoperative complications were observed. The followup time was from 6 to 24 months.
RESULTS: The mean preoperative axial length was 28.3mm. Best corrected visual acuity reached 0.2 or better in 35 eyes (95％) and 0.5 or better in 33 eyes (89％). None eye had posterior capsule rupture. CorneaI edema was found in 2 eyes and ocular hypertension was found in 1 eye on the first day after the surgery. Two eyes developed after cataract. Macular degeneration and retinal hemorrhage were found on 4 cases after the surgery. No retinal or choroid detachment.
CONCLUSION: It is safe and effective for high myopia with cataract to implant folding intraocular lenses after phacoemulsification.
KEYWORDS: phacoemulsification; lens implantation; intraocular; high myopia
Huang YL, Huang X, Zhou LJ, et al. Cataract phacoemulsification combined intraocular lens implantation in 27 high myopia cases. Int
J Ophthalmol (Guoji Yanke Zazhi) 2008;8(11):23482349
0引言
我们于2006 03/2008 03对高度近视合并白内障的患者，行超声乳化白内障吸除联合折叠人工晶状体植入术，共27例（37眼），随访1～2 a，现报告如下。
1对象和方法
1.1对象 本组27例(37眼)。其中男11例(19眼)，女16例(18眼)。年龄47～86（平均69）岁。核性浑浊15眼(40％)，后囊下浑浊14眼(38％)，皮质浑浊8眼(22％)。晶状体核硬度的分级：按照LOCS II分级 ，其中I级核3眼，II级核19眼，III 级核15眼。术前最佳矫正视力光感～0.1者23眼(62％)，0.1～0.4者14眼(38％)。眼轴长度介于25.0～34.6(平均为28.3)mm。其中介于26.0～27mm者19眼(51％)，≥27mm者18眼(49％)。眼压均属正常范围。人工晶状体度数：+15.50～ 4.00D。每位患者均经眼B超了解玻璃体及眼底情况。且根据散瞳查眼底情况，术前行OCT或mERG检查。人工晶状体的屈光度计算：根据测量的角膜曲率、眼轴长度，眼轴≥27mm应用SRK/T公式计算人工晶状体屈光度，眼轴<27mm应用SRK/Ⅱ计算人工晶状体度数[1]， 并根据术后视力要求选择人工晶状体以兼顾部分患者视近需要。术后随访1～2（平均1.5）a。
1.2方法 手术均由同一位经验丰富手术医生担任,术前30min用复方托品酰胺滴眼液散瞳。3g/L氧氟沙星滴眼液冲洗结膜囊。5g/L爱尔卡因滴眼液表面麻醉。开睑器开睑，透明角膜切口，主切口在上方或右上方，辅助角膜切口位于主切口左侧80°左右，前房内注入粘弹剂，连续环形撕囊，水分离及水分层。软核白内障采用原位乳化法；硬核性白内障分别采用劈核法 、对压法、填塞法的乳化法。注吸残余皮质。注入粘弹剂，切口扩大至3.2～6.5mm，用推注器或折叠镊将折叠式人工晶状体植入晶状体囊袋内，或植入大直径人工晶状体，置换出前后房粘弹剂。水封角膜切口，必要时10 0线缝合一针。
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