作者:白华,张 燕,王宗华,李耀宇
作者单位:中国北京市,北京军区总医院眼科
【摘要】 目的:探讨初学者对于小切口白内障的手术技巧以及相关并发症的发生原因和处理方法。 方法:回顾分析87 例(93 眼) 采用小切口白内障囊外摘除联合人工晶状体植入手术。结果:术后裸眼视力≥0.5 的眼数术后1d,1wk,1mo分别为35眼(38%),50 眼(54%) ,74 眼(80%);术中及术后发生了一些并发症(如晶状体后囊膜破裂,虹膜睫状体炎,瞳孔变形,人工晶状体偏位等),予以相应处理,矫正视力≥0.3。 结论:小切口白内障手术具有安全经济的特点,充分的术前准备和每一手术步骤的细致操作对于初学者来说是必要的保证,连续的环形撕囊是减少术后并发症的关键,来自上级医生的正确指导也是手术顺利的重要因素。
【关键词】 白内障;小切口;并发症
Experience of small incision cataract surgery for beginner
Hua Bai, Yan Zhang, ZongHua Wang, YaoYu Li
Department of Ophthalmology, Beijing Military General Hospital, Beijing 100700, China
AbstractAIM: To explore the efficacy, skills and complications of small incision cataract surgery for beginner.
METHODS: Eightyseven cases (93 eyes) underwent small incision cataract surgery combining with lens implantation in our hospital were retrospectively analyzed.
RESULTS: The uncorrected visual acuity 0.5 or better were 35 eyes (38%), 50 (54%), and 74 (80%) 1 day, 1 week, and 1 month after operation, respectively. The complications including posterior capsular rupture, iridocyclitis, mild pupil deformation, and IOL decentration could be deal with and vision recovered with better visual acuity ≥0.3.
CONCLUSION: Small incision cataract surgery is safe, effective and economic. Beginners need more working and preparing before operation and do well each step. Posterior continuous curvilinear capsulotomy is a key to avoid more complications. Advice from supervisor is very important too.
KEYWORDS: cataract; small incision; complication
Bai H, Zhang Y, Wang ZH, et al. Experience of small incision cataract surgery for beginner. Int J Ophthalmol(Guoji Yanke Zazhi) 2008;8(11):23502351
0引言
小切口白内障手术由于其自身经济简便、易于普及等优点,已在我国各地各层次的医院得到了大力的推崇[14],它也是眼科医生熟练掌握超声乳化手术前的一个基础技能,我们作为一个小切口白内障的初学者,总结了其中容易遇到的一些问题和注意事项。
1对象和方法
1.1对象 回顾分析2007 03/12手术的白内障患者87例(93眼),年龄24~89(平均为56.6)岁,男47例,女40例。其中老年性白内障68眼,糖尿病性白内障12眼,外伤性白内障6眼,青光眼并发白内障7眼。术前最好矫正视力<0.05者70眼,0.05~0.2者23眼。
1.2方法 球周或半球后麻醉后,常规消毒铺单再消毒,上直肌缝线,1∶00~11∶00方位剪开球结膜,灼烧巩膜表面血管,角膜缘后2mm,平行切口或弧形切口长约5mm,做巩膜隧道分离至角膜缘前2mm,穿刺入前房,粘弹剂充满前房后,环形撕囊或截囊,水分离囊膜和皮质,将核旋转入前房,出核,吸出残留皮质,植入人工晶状体入囊袋内,恢复前房,灼烧法闭合结膜伤口。
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