作者：张超，贾 丽，王晓鲁 作者单位：(710054)中国陕西省西安市，武警陕西总队医院眼科
【摘要】 目的:探讨白内障超声乳化人工晶状体植入术的临床疗效，分析手术并发症及其处理。方法：对965例1024眼白内障患者行透明角膜或巩膜隧道切口白内障超声乳化人工晶状体植入术，总结分析术后低视力原因及手术并发症。结果：顺利完成超声乳化术998眼(97.46%)，26眼改为ECCE+IOL术;术后最佳矫正视力(术后1mo)：视力<0.3者141眼(13.77%)，视力0.3～0.8者730眼(71.29%)，视力≥1.0者153眼(14.94%);术中后囊膜破裂41眼(4.00%)，撕囊失败16眼(1.56%)。虹膜损伤5眼(0.49%)，核坠入玻璃体腔者2眼(0.20%)。术后角膜水肿98眼(9.57%)，一过性高眼压31眼(3.03%)，人工晶状体坠入玻璃体腔者1眼(0.10%)，眼内炎4眼(0.39%)，眼球萎缩2眼(0.20%)。结论:白内障超声乳化人工晶状体植入术具有创伤小、恢复快，术后视力满意等优点，但是了解手术并发症原因，减少和避免并发症的发生以及正确处理并发症，是手术成功的保障。
【关键词】 白内障;超声乳化;手术并发症
Clinical analysis of phacoemulsification in 965 cases
Chao Zhang, Li Jia, XiaoLu Wang
Department of Ophthalmology, Shaanxi Provincial Corps Hospital, Chinese Peoples Armed Police Forces, Xian 710054, Shaanxi Province, China
Abstract
AIM: To analyze the clinical curative effect and operation complications in the process of extracapsular extraction of cataract by phacoemulsification.
METHODS: Nine hundred and sixtyfive cases(1024 eyes)of cataract were treated by corneal tunnel incision or sclera tunnel incision phacoemulsification cataract extraction,and analysed the reason of low vision and the operation complications.
RESULTS:Phacoemulsitlcation was performed succcssfially on 998 eyes(97.46%) ,and 26 eyes were changed to extracapsular cataract extraction combined with intraocular lens implantation. 141 eyes(13.77%) attained corrected vision under 0.3; 730 eyes(71.29%) attained corrected vision of 0.3 to 0.8; 153 eyes(14.94%) attained corrected vision of 1.0 or better after operation in four week. During the operations there were capsular rupture in 41 eyes(4.00%), defeated capsulorhexis in 16 eyes(1.56%), damage of iris in 5 eyes(0.49%), fallen nucleus in vitreoas cavity in 2 eyes (0.20%), corneal endothelial edema 98 eyes (9.57%), intraocular hypertension 31 eyes(3.03%), artificial lens fallen nucleus in vitreoas cavity in 1 eye (0.10%), entophthalmia in 4 eyes (0.39%) and atrophy of eyeball in 2 eyes(0.20%).
CONCLUSION: The extraction of cataract by phacoemulsification and embedding of artificial crystal may have less tissue damage,and vision recover quickly.Though it is an effective method, to understand the reason for operation complication,to reduce the operation complication and to avoid it can ensure the success of operation.
KEYWORDS: cataract;phacoemulsitication;operative
0引言
白内障是主要的致盲眼病之一，目前治疗仍以手术为主。白内障超声乳化吸除联合后房型人工晶状体植入术损伤小,效果好,深受眼科医师及广大白内障患者喜爱。回顾分析我院在200301/200806共行965例1024眼白内障超声乳化人工晶状体植入术的临床疗效，并分析手术并发症的原因及其处理,为白内障医师提供更多的临床经验。
1对象和方法
1.1对象 我院200301/200806施行白内障超声乳化摘除联合人工晶状体植入术共965例1024眼，其中男580例534眼，女385例490眼，年龄4～89(平均65)岁。其中单纯老年性白内障702眼，白内障伴青光眼22眼，青光眼术后白内障30眼，白内障伴糖尿病者178眼，白内障伴有高度近视者42眼，色素膜炎并发性白内障22眼，外伤性白内障9眼，先天性白内障17眼，晶状体脱位2眼。按LocsⅡ[1]分类方法对晶状体核进行分级，Ⅰ级核73眼，Ⅱ级核217眼，Ⅲ级核416眼，Ⅳ级核309眼，V级核9眼。术前视力：光感～0.5。手术设备使用美国眼力健公司生产的 SOVERIGH W型超声乳化仪;德国蔡司双目手术显微镜;正大爱维及海诺特透明质酸钠;折叠人工晶状体。术中超声乳化能量1.66%～21.5%，负压300mmHg，超声乳化时间0.2～23s。
1.2方法 手术前1～2h用复方托品卡胺滴眼液散瞳至6～10mm，表麻滴瞳点眼表面麻醉，开睑器开睑，采用上方透明角膜或巩膜隧道切口，注入黏弹剂，行连续环形撕囊，撕囊直径5～7mm，2∶00方位角膜缘内做辅助侧切口，水分离晶状体核及皮质，在虹膜平面或囊袋内结合劈核技术进行原位超声乳化吸出晶状体体核及皮质。若术中一旦发现后囊膜破裂，立即停止超声乳化，注入黏弹剂于后囊平面，用晶状体勺或晶状体镊取出晶状体核，手工吸或干吸法清除皮质，行前段玻璃体切除至瞳孔恢复圆形。根据后囊破裂的大小、位置及前囊情况，继续植入人工晶状体于囊袋或睫状沟内，前后囊膜破损严重则进行人工晶状体缝合固定。注吸前房内残留的黏弹剂，水密闭切口，单眼遮盖，术后口服抗生素。
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