【摘要】 目的：设计一种合理的非超声乳化小切口白内障囊袋内劈核方法应用于临床，并观察其效果。方法：用自行设计的劈核器械和术式行III级核以上白内障囊袋内劈核。随机将III～V级核白内障399眼分成两组。囊袋内劈核组（实验组）211眼，前房内劈核组（对照组）188眼。实验组及对照组均行连续环形撕囊（contrnuous circular capsulorhexis, CCC）充分水分离，实验组在粘弹剂的保护下用钩刀劈裂法行囊袋内劈核；对照组将核旋出囊袋浮至前房，在粘弹剂的保护下用双刀水平面劈核法，行前房内劈核，均劈成两块核瓣。扩大切口至5.5mm，用3mm圈匙娩出核瓣。观察两组术后1，7d视力、术后反应及并发症情况。结果：两组术后第1d视力及术后反应，术后近期并发症比较，经统计学处理均有显著意义(P<0.01)。两组术后第7d视力，并发症和角膜散光度数无统计学意义。结论：非超声乳化小切口白内障囊袋内劈核比前房内劈核术后短期反应更轻，并发症少，是一种非超声乳化白内障手术更合理的劈核方法。同时可作为超声乳化手术初学者过渡术式。
【关键词】 白内障；非超声乳化；劈核；囊袋内；小切口
Application of chop nucleus with clasp and knife in the capsular bag in smallincision nonphacoemulsification
JiPu Bu, XiangDong Chen, LiuQing Wu, YuHui Xiao, SuXia Peng, Yan Yang, Shan Hu
Department of Ophthalmology, Liuyang Eye Hospital of Hunan Province, Liuyang 410300, Hunan Province, China
Abstract AIM: To invent a nucleus chop skill in the capsular bag in smallincision nonphacoemulsification and to observe its effect.
METHODS: We applied nucleus chop in over grade III nucleus with the instrument and nucleaus chop skill invented by us. A total of 399 patients (399 eyes) with over grade III nucleus were randomly divided into two groups, Group 1(experiment group, 211 eyes), Group 2 (control group, 188 eyes). Both groups were performed continuous curvilinear capsulorhexis and adequate hydradissection. The emperiment group were performed nucleus chop in the capsular bag, and the control group turn nucleus to anterior chamber and chop nucleus there. All incision broadened to 5.5mm, and nucleus chip were removed with a 3mm lens loop. The visual acuity on day 1 and 7 after surgery, postoperative reaction and complications of two groups were observed.
RESULTS: The visual acuity and complications of two groups on day 1 after surgery had statistically significant difference (P<0.01). And on day 7 after surgery, the visual acuity, complications and corneal astigmatism of two groups had no significant difference.CONCLUSION: Chop nucleus in the capsular bag of surgery is safe and effective. The complications are less than chop nucleus in anterior chamber in the short range. Chop nucleus in the capsular bag is a better way in nonphacoemulsification. That is a transition way for beginner to learn phacoemulsification.
KEYWORDS: cataract; nonphacoemulsification; chop nucleus; in the capsular bag; smallincision
0引言
自日本白内障专家Momos发明小切口无缝线非超声乳化白内障人工晶状体植入术以来，国内学者已有大量的文献报告。术中取核方法比较多，如整体托出法和各种前房内劈核法。其中包括立体操作法与水平面操作法[1]，各有其优缺点。我院在双刀水平面劈核法的基础上设计出非超声乳化小切口白内障囊袋内劈核方法—钩刀劈裂法施行白内障摘除及人工晶状体植入术，取得良好效果。现将我们20060530/0630在湖南长沙市政府八件实事之一“千人复明工程”中本院所做的手术399眼随机分为囊袋内劈核组211眼，前房内劈核组188眼，其结果报告如下。
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