【摘要】目的：分析西藏地区白内障的特点,并探讨健康快车西藏站白内障超声乳化联合人工晶状体植入术的疗效。方法：对西藏地区872例白内障的类型特点进行分析,并观察白内障超声乳化联合人工晶状体植入术的撕囊成功率,人工晶状体植入率,术中术后并发症及术后视力。结果：总共872眼,其中白色白内障705眼(80.8%);IV级核以上411眼(47.1%)。872眼术中撕囊成功率达98。9%,术后836眼第1d视力,＜0.1者210眼(25。1%),0.1~0.25者210眼(25.1%),0.3~0.5者220眼(26.3%),0。6~0.8者140眼(16.7%),≥1.0者56眼(6.7%)。并发症:术中后囊破裂10眼(1.1%),术后角膜水肿124眼(14.2%)。结论：西藏地区白内障以过熟期白内障和硬核（IV级以上）白内障居多。白内障超声乳化联合人工晶状体植入术的疗效明显。
【关键词】 西藏；白内障超声乳化；人工晶状体
Therapeutic effect of phacoemulsification in 872 eyes of cataract on Tibet lifeline express
HuiChun Huang,ChuKai Huang,HongPing Nie,YingZi Pan,ShaoBin Zhang
1Joint Shantou International Eye Center of the Shantou University and the Chinese University of Hongkong, Shantou 515041, Guangdong Province, China; 2 Department of Ophthalmology, the First Hospital of Peking University, Beijing 100034, China
Correspondence to: ShaoBin Zhang. Joint Shantou International Eye Center of the Shantou University and the Chinese University of Hongkong, Shantou 515041, Guangdong Province, China. [email protected]
AbstractAIM: To analyze the characteristic of cataract in Tibet area, and to evaluate the therapeutic effect of phacoemulsification combined with intraocular lens implantation for cataract on Tibet lifeline express. METHODS: Totally 872 eyes with cataract on Tibet area were examined and analyzed, and phacoemusification combined with intraocular lens implantation were performed on them. The successful rate of capculorhexis and the rate of IOL inserted, intraoperative complication and postoperative complication, visual acuity of postoperative day 1 were recorded.RESULTS: Among 872 eyes, 705 eyes were white cataract (80.8%), 411 eyes with IV level of nucleus (47.1%). The successful rate of capculorhexis was 98.9%. On postoperative day 1, the VA of less than 0.1 in 210 eyes (25.1%), 0.1 to 0.25 in 210 eyes (25.1%), 0.3 to 0.5 in 220 eyes (26.3%), 0.6 to 0.8 in 140 eyes (16.7%), more than 1.0 in 56 eyes (6.7%). Complications: There were 10 eyes (1.2%) with posterior capsule ruptured during operation and 124 eyes (14.2%) with cornea edema on postoperative day 1.CONCLUSION: There are more eyes with hard or hypermature cataract in Tibet area. The effect of phacoemusification combined with intraocular lens implantation on Tibet lifeline express is notable.
KEYWORDS:Tibet;phacoemusification;intraocular lens
0引言
西藏位于我国西部高原地区,平均海拔4260m。由于紫外线、缺氧、营养等原因其高原白内障发病率明显高于平原地区[1]，加之西藏高原少数民族卫生防病知识缺乏、交通不便、就诊晚，致使成熟期白内障明显多于平原地区。健康快车是香港同胞捐赠给大陆地区用于贫困地区白内障复明手术的列车医院。200706/07健康快车在西藏拉萨施行白内障手术 872例,现将西藏地区的白内障特点及白内障超声乳化联合人工晶状体手术的疗效汇报如下。
1对象和方法
1.1对象
共有872例白内障患者,其中男 448例,女 424例,年龄11~97(平均63.5±11.6)岁,其中60岁以上占67.5%。独眼患者8例（0.9%）。先天性白内障10眼（1.1%）;并发性白内障16眼（1.8%）;外伤性白内障8眼（0.9%）。术前视力光感至指数的占96.3%,0.02~0。4的占3.4%。其中白色白内障705例,占80.9%;晶状体核硬度采用根据LOCS II白内障分级标准, IV级核以上411眼占47.1%。
1.2方法
术前检查：查视力和光定位,使用角膜曲率计及眼科A 超测定角膜曲率及眼轴长度, SRK II 公式计算晶状体度数, 以轻度近视( 0.5D)原则选择人工晶状体的屈光度。B超排除视网膜脱离等眼内疾病[2]。术前美多丽眼药水充分散瞳,采用表面麻醉(倍诺喜眼药水滴眼3次),用3.0三角刀做上方透明角膜切口,前房注入玻璃酸钠粘弹剂或透明质酸钠粘弹剂(其胜,上海其胜生物制剂实业有限公司)。连续环形撕囊,水分离后囊袋内原位超声乳化晶状体核(超声乳化机为美国爱尔康公司Legacy 20000型),充分采用劈核技术[3],残余晶状体皮质采用自动灌注抽吸系统吸出。注入粘弹剂后扩大切口至6.0mm,植入PMMA人工晶状体于囊袋内。吸出囊袋内及前房粘弹剂,恢复前房,水封切口,检查切口密闭情况。除2例缝合一针外,其余病例不需缝合。
2结果
2.1视力
除6位患者术后视力检查不配合及最后30位手术患者未登记外,共有836眼。术后第1d视力分布为:＜0.1者210眼,占25.1%;0.1~0.25者210眼,占25。1%;0.3~0.5者220眼,占26.3%;0.6~0.8者140眼,占16.7%;≥1.0者56眼,占6.7%。
2.2术中并发症
术中后囊膜破裂10例(1.1%),其中玻璃体脱出2例,经处理后均植入人工晶状体。虹膜损伤1例。
2.3术后并发症
术后最多见的并发症是角膜水肿,共有124例出现不同程度的角膜水肿,占14.2%。其中以IV级核术后出现角膜水肿为主。角膜水肿的程度与核硬度及超声乳化时间、能量成正比。术后1wk回基地医院复查的角膜水肿患者均恢复透明。未发现有因角膜内皮失代偿者。未发现眼内炎者。
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