【摘要】 目的:探讨在针拨白内障术后应用小切口白内障摘除联合人工晶状体睫状沟悬吊固定手术的有效性和安全性。
方法: 对20例(21眼)针拨白内障术后患者进行白内障取出人工晶状体睫状沟悬吊固定术。随访3～12mo,观察术后视力、眼压、术中术后并发症及术后人工晶状体的位置。
结果:术后第1d裸眼视力: 0.4～0.5者7眼,0.6～0.8者14眼。术后7d进行显然验光，平均为（0.87±0.43）D，与手术前设计保留（0.50～1.00）D接近。术后3mo平均度数为(0.68±0.33)D。手术后7d眼压平均为17.11±3.13mmHg，术后3 mo平均眼压为14.17±2.03mmHg。手术中入、出针时，发生少量出血2眼；术后角膜切口周围轻度水肿5眼，3～5d基本消退。结膜下出血4例，5～7d后自行吸收。随访观察3～12mo，21眼手术后人工晶状体位置均保持良好的居中性。未发现角膜内皮功能失代偿、青光眼、视网膜脱离等情况。
结论:针拨白内障术后应用小切口白内障摘除联合人工晶状体睫状沟悬吊固定手术是安全、有效的。
【关键词】 针拨白内障；小切口；白内障摘除；人工晶状体悬吊术
Small incision cataract extraction and ciliary sulcus suture of PC IOL after couching surgery
ZhiHui Zhang
Department of Ophthalmology, the Peoples Hospital, Heyuan 517000, Guangdong Province, China
Abstract
AIM: To investigate the effectiveness and safety of small incision cataract extraction and ciliary sulcus suture of PC IOL after couching surgery
METHODS: Small incision cataract extraction and ciliary sulcus suture of PC IOL was performed in 20 cases (21 eyes) after couching cataract surgery. The follow up period was from 3 to 12 months. Postoperative visual acuity, IOP, intra and postoperative complications and the location of intraocular lens were observed.
RESULTS: On day 1 after operation, the visual acuity of seven eyes was 0.40.5, 14 eyes in 0.60.8. The mean of manifest refraction after 7 days was (0.87±0.43)D, which was closed to the preoperative designing of (0.50～1.00)D. The mean degree was (0.68±0.33)D three months after operation. The mean IOP was 17.11±3.13mmHg and 14.17±2.03mmHg after 7 days and 3 months, respectivley. There were 2 eyes with minor hemorrhage when the needle pierced into and pulled out. Five eyes presented mild edema around the corneal incision after operation and disappeared after 35 days. Four cases were subconjunctival hemorrhage and spontaneously absorbed after 57 days. At the follow up period, the location of intraocular lens in all 21 cases was placed in the middle well. There were no function decompensation of corneal endothelium, glaucoma, retinal detachment and other complications.
CONCLUSION: The surgical method of small incision cataract extraction and ciliary sulcus suture of PC IOL after couching surgery is safe and effective.
KEYWORDS: couching cataract surgery; small incision; cataract extraction; ciliary sulcus suture of PC intraocular lens
0引言
白内障是危害老年人视觉健康的头号敌人。目前，最好的治疗手段是白内障摘出人工晶状体植入手术。黄金或主流术式有超声乳化手术和手法小切口手术。手术效果令人满意。但在一些经济技术落后的地区，仍然有人进行白内障针拨手术，社会上存在有一批针拨白内障术后患者。这部分患者手术后由于出现并发症或手术效果不好，或者手术配戴眼镜不方便，或和其他人工晶状体植入手术术后患者比较术后效果差异较大等原因，他们或家属希望能再次手术，提高视力或方便生活。我们近年有机会在贵州某地接诊了一些白内障针拨术后的患者，进行晶状体取出人工晶状体悬吊手术治疗，效果满意。报告如下。
1对象和方法
1.1对象 本组病例20例（21眼），白内障针拨术后6～120mo就诊接受手术。男9例，女11例，年龄63～85(平均75)岁。患者自愿要求接受手术者；入院常规项目检查，无手术禁忌证；镜片矫正视力能够达到满足生活需要，自述满意,本组病例矫正视力均≥0.3；眼压测量在正常范围；有慢性葡萄膜炎症状，只要眼压正常，控制炎症后选择手术。散瞳检查晶状体没有下沉到眼球后极部；眼科A/B超检查没有视网膜脱离。生物测量（眼轴）采用A超手动模式或者A+B模式；双眼病例（1例），左右眼手术时间间隔7d（或以上）。
1.2方法 表面麻醉或球后阻滞麻醉。沿角膜缘剪开上方球结膜，分离止血，做反眉型切口约7mm，隧道分离到透明角膜内约1mm，穿刺进入前房。缓慢放出房水，脱位晶状体随着水流上浮到瞳孔区或者赤道部进入瞳孔区或前房，注入粘弹剂，特别注意将玻璃体压向后方。扩大切口，三明治法娩出晶状体。选择2∶00，8∶00点位，做结膜切开，用聚丙烯缝线，距角膜缘后约2mm平行于虹膜面入、出针，将人工晶状体双襻缝合固定于2∶00，8∶00位睫状沟，缩小瞳孔。平衡盐液置换粘弹剂，检查切口无渗漏。结膜下抗菌消炎处理，单眼包扎。随访观察3～12mo。观察术后视力、眼压、术中术后并发症及人工晶状体的位置。
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