【摘要】 目的：探讨75岁以上高龄老年白内障行透明角膜切口超声乳化联合疏水性硅凝胶人工晶状体植入术的安全性和疗效。方法：对随访1a资料完整75岁以上老年白内障透明角膜切口超声乳化联合疏水性硅凝胶人工晶状体植入病例65例（73眼）进行临床分析,并随机选择同期47～70岁年龄组老年白内障45例(56眼)作对照组。结果：术后两组所有患者视力有不同程度的提高,高龄组术后3mo,最佳矫正视力大于0.5的有62眼(占84.9%),与对照组比较差异无统计学意义（P>0.05）。两组透明角膜切口术后1wk，1mo平均角膜散光度与术前比较均差异有统计学意义(P<0.05)；而两组术后3mo平均角膜散光度与术前比较差异均无统计学意义(P>0.05)。术中后囊膜破裂发生率及术后1a后囊膜混浊发生率两组差异无统计学意义（P>0.05）；无其他严重手术并发症发生。结论：高龄老年白内障行透明角膜切口超声乳化术联合疏水性硅凝胶人工晶状体植入是安全有效的，术前需进行详细的全身及眼部检查,选择适合个体的麻醉方式。
【关键词】 高龄;白内障;透明角膜切口;超声乳化;硅凝胶；人工晶状体
Clinical observation of clear corneal incision phacoemulsification combined with silicone IOL implantation among senile cataract patients
Jin Ma, Yong Zhong, MeiChan Lu, FangTian Dong
1Department of Ophthalmology, Peking Union Medical College Hospital,Beijing 100730, China; 2Department of Ophthalmology, Centro Hospitalar Conde de So Jannrio (CHCSJ), Macao CP 3002, China
Correspondence to: Yong Zhong. Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China. yzhong[email protected]
AbstractAIM: To evaluate the effect and safety of the clear corneal incision phacoemulsification combined with hydrophobic silicone intraocular lens implantation in cataract patients aged over 75 years old. METHODS: A series of 73 eyes of 65 cases (senile cataract patients) that received clear corneal incision phacoemulsification combined with hydrophobic silicone intraocular lens implantation were analyzed retrospectively, while 56 eyes of 45 cases (cataract patients aged between 4770 years old) were studied as control. RESULTS: The best corrected visual acuity of both groups was improved postoperatively. Sixtytwo senile eyes (84.9%) had achieved a BCVA of 10/20 or better at 3 months postoperatively. BCVA showed no statistically significant difference (P>0.05) between two groups. The mean corneal astigmatism of both groups presented a significant difference between preoperatively and first week postoperatively, as well as first month postoperatively (P<0.05), without statistical difference (P>0.05) at the third month postoperatively. The incidence of posterior capsule rupture during operation and posterior capsule opacification at one year postoperatively showed no statistical difference (P>0.05)between two groups. No severe complications occurred during the operation. CONCLUSION: The clear corneal incision phacoemulsification combined with hydrophobic silicone intraocular lens implantation in senile cataract patients is effective and safe. Topical and systemic examination will be made carefully before operation. Suitable anesthesia should be selected depending on the different patients.
KEYWORDS: senile; cataract; clear corneal incision; phacoemulsification; hydrophobic silicone; intraocular lens
引言
随着人们生活水平和保健意识的提高，社会的人口老龄化越来越严重，如何提高高龄老年白内障患者的手术效果，以改善他们的生活质量越来越受到大家的关注。透明角膜切口超声乳化联合人工晶状体植入术与传统现代囊外摘除手术相比，具有安全、切口愈合快、散光小及视力恢复快的特点，我们对75岁以上高龄老年白内障患者采用此种术式并植入疏水性硅凝胶人工晶状体(IOL)，将随访1a资料完整病例分析如下。
1对象和方法
1.1对象
选择200401/200606期间行透明角膜切口白内障超声乳化联合疏水性硅凝胶IOL（CeeOn 911A）植入、年龄在75岁以上随访资料完整老年性白内障65例（73眼）进行分析，其中男19例，女46例。平均年龄78.85±4.67（75～95）岁；其中75～80岁41例，81～85岁18例，86～90岁4例，91～95岁2例。入院至手术时间为1d，住院时间为3～5d。手术由两名熟练眼科操作的医生完成。经术前检查全身患糖尿病16例、高血压7例、耳聋2例、心脏病1例；眼部患青光眼3例、高度近视2例、角膜斑翳1例；术前经治疗待全身及眼部病情平稳后方可手术。高龄组术前视力光感～0.4，白内障晶状体核混浊Ⅰ级7眼，Ⅱ级45眼，Ⅲ级12眼，Ⅳ级9眼(LOCSⅡ标准)。所有患者术后1d，1wk，1，3mo，0.5a及1a行最佳矫正视力（BCVA）、眼压、裂隙灯、散瞳眼底、电脑验光、后囊膜混浊（PCO）情况检查。术后病例随访均由一名眼科医生完成。并随机选择同期47～70岁年龄段术后随访资料完整的老年白内障45例(56眼)作对照组。患者一般资料详见表1。表1两组患者一般资料特性（略）
1.2方法
术前全面了解全身及眼部情况并与患者及家属耐心讲解手术过程,在取得患者及家属的同意下选择适合患者个体的麻醉方式。本高龄组65例中表麻48例，球后麻醉16例，全麻1例。高龄组全部病例均在心电监护下进行手术。全部术眼使用DGH4000型A超测量仪测量眼轴长度，TOPCON8100自动验光角膜曲率仪测量角膜曲率，按SRKⅡ公式计算IOL度数。一般选择术后屈光为0.5DS的IOL度数。IOL度数范围详见表1。全部植入荷兰Pharmacia公司生产的疏水性硅凝胶IOL (CeeOn 911A)。术前选用美多丽P滴眼液散瞳，表麻、球后麻醉或全麻后，采用右上方（左眼鼻上方，右眼颞上方）透明角膜自闭式切口，距顺时针2点处穿刺为辅助切口。前房注入Healon，连续环形撕囊，直径控制在5～5.5mm，皮质水化，使用UniversalⅡ超声乳化仪（美国 ALCON公司生产）在囊袋内或虹膜平面乳化晶状体核，超声能量15%～30%，平均（22.5±4.7）%,超声时间为0.5～2.75min,平均1.37min。应用低能量和高负压的超声乳化技术完成手术，以减少高能量对角膜内皮的损伤。抽吸晶状体皮质，并进行后囊膜抛光。囊袋内注入粘弹剂，用推注器将折叠IOL植入囊袋内，调整IOL位置。冲洗前房，切口水密状态不佳者间断缝合1针，部分病例应用卡米可林缩瞳。结膜下氟美松2.5mg、妥布霉素2万U注射，所有病例均采用统一的术后用药方案；两组均无因全身疾病中断手术者。
统计学处理：采用SPSS11.0统计软件对数据进行统计学分析。
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