【摘要】 目的:探讨小切口非超声乳化白内障摘除联合人工晶状体植入术在三峡库区复明手术中的应用效果。方法:对658眼白内障复明手术进行回顾性研究。结果:术后1wk内视力>0.5的眼数为258眼(39.2%),脱残者586眼(89.0%),脱盲者648眼(98.5%),I期植入人工晶状体643眼,植入率97.7%。术中及术后无严重并发症发生。结论:在基层医院复明行动中适宜应用小切口非超声乳化白内障摘除人工晶状体植入术,术后视力恢复良好,能确保实现复明手术治疗“大量、高质、低价”目标。
【关键词】 复明手术;白内障;小切口;人工晶状体
Application of small incision extracapsular cataract extraction and intraocular lens implantation in blindness prevention and
treatment
LiMing Wang1, HuiLi Li2
1Department of Ophthalmology and Otorhinoloryngology, Chongqing Fengjie County Peoples Hospital, Chongqing 404600, China; 2Department of Ophthalmology, the 8th Hospital of Chongqing, Chongqing 400015, China
AbstractAIM: To explore the application effect of small incision extracapsular cataract extraction and intraocular lens implantation in Vision Recovered Action of the Three Gorges Reservoir area.
METHODS: Retrospective study was taken on 658 eyes of cataract patients in Vision Recover Action.RESULTS: Among 658 eyes of cataract patients, the bestcorrected vision in 258 eyes(39.2%) was over 0.5 within one week,586 eyes (89.0%) got out of disablement with the vision ≥0.3,648 eyes(98.5%)got out of blindness with the vision >0.05, and 643 eyes(97.7%) were implanted artificial lens. There were no serious complication in or after epenation.CONCLUSION: Small incision extracapsular cataract extraction and intraocular lens implantation is an effective operation which can be applied in rural areas. It can ensure the goal of “largescale, highquality,lowcost” in Vision Recover Action.
KEYWORDS: Vision Recover Action; cataract; small incision; intraocular lens
0引言
我国目前盲人中约有半数是白内障引起的,每年新增白内障盲人约为40万,随着人口增加和老龄化,这一数字还会增加[1],因此根治白内障盲是我国开展防盲治盲工作的首要任务,目前我们应当尽快地实现大量、高质和低价治疗白内障盲的目标[2]。小切口非超声乳化白内障摘出术具有设备要求低、手术切口小、术后视力恢复快等优点,多用于偏远及生活条件差尚难以普及推广超声乳化地区的复明手术中[3]。近几年我院眼科在参与防盲治盲复明行动中采用反眉式巩膜隧道切口白内障囊外摘出联合人工晶状体植入术,取得了良好社会效益,现报告如下。
1对象和方法
1.1对象
200707/200910我院眼科承担山峡库区的白内障防盲治盲复明手术任务,共施行小切口白内障囊外摘出手术627例658眼,其中男338例360眼,女289例298眼。年龄28~90(平均 56.7)岁。老年性白内障580例609眼,外伤性白内障13例13眼,并发性白内障34例36眼。术前视力:光感者312眼,0.01~0.04者262眼,0.05~0.10者84眼。患者均为县残联组织筛选的贫困户,严格全面内科体检,无严重心血管疾患,血糖控制在正常范围。眼科常规检查及角膜曲率、眼A/B超专项检查,电脑程序SRK—11公式计算所需人工晶状体屈光度。
1.2方法
手术当日术眼局部频点抗生素滴眼液3次,术前30 min给予美多丽散瞳,倍诺喜眼药水表面麻醉,开睑器开睑,上直肌牵引缝线, 10∶00~2∶00之间作以穹隆为基底的结膜瓣,巩膜表明烧灼止血。然后用安全刀片作5.5mm的反眉式巩膜隧道切口,深度为巩膜厚度的一半,外切口距角膜缘1.5~2mm。向前作巩膜隧道至角膜缘前界约1mm的透明角膜处,穿刺进入前房,注入黏弹剂,自制截囊针环形撕囊或开罐式截囊,水分离晶状体核,转动晶状体核并使其上方赤道部翘入前房,晶状体核上下均注入黏弹剂保护角膜上皮及晶状体后囊,扩大隧道内口使其大于外切口而呈梯形,将注水晶状体圈匙伸入核的后方,轻压切口后唇,托起核缓慢退出晶状体圈匙,晶状体核随同滑出。双套管注吸器吸净皮质,前房及囊袋内注入黏弹剂,植入爱尔康Type05或宇宙Styce直径为5.5mm的PMMA人工晶状体,调整位置。根据瞳孔大小酌情使用卡米可林。置换出囊袋内及前房残留的黏弹剂,恢复前房,切口无需缝合,术毕结膜囊涂典必殊眼膏单眼包扎。术后1d换药以托品酰胺活动瞳孔,术后2d以典必殊滴眼液开放滴眼。
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