【摘要】 目的：探讨白内障小切口囊外摘除人工晶状体植入术的手术技巧及临床效果。方法：对200704/200812小切口白内障囊外摘除人工晶状体植入术312例312眼回顾性分析。结果：术后视力明显提高，≥0.05者307眼，脱盲率98.4%;≥0.3者285眼，脱残率91.3%。术中、术后并发症：后囊膜破裂4眼(1.3%);术后角膜水肿75眼(24.0%);虹膜损伤 2眼(0.6%);术后暂时性高眼压5眼(1.6%);瞳孔轻度变形者6眼(1.9%);人工晶状体夹持2眼(0.6%);术后葡萄膜炎12眼(3.8%);人工晶状体未能一期植入者5眼(1.6%);1wk后角膜平均散光1.53±1.32，经处理未见严重并发症发生。结论：白内障小切口囊外摘除人工晶状体植入术，疗效显著、并发症少，安全易行，特别是对基层医院不失为防盲复明手术的首选术式。
【关键词】 白内障;小切口;囊外摘除;人工晶状体
Clinical analysis of 312 cases small incision cataract extraction and intraocular lens implantation
GuiLian Jing, YueLi Li, Jun Yue
Eye Hospital of Puyang, Puyang 457000, Henan Province, China
Correspondence to: GuiLian Jing. Eye Hospital of Puyang, Puyang 457000, Henan Province China. [email protected]
Received:20100708 Accepted:20100809
Abstract
AIM: To investigate the clinical effect of small incision extracapsular cataract extraction and intraocular lens implantation.
METHODS: From the April 2007 to December 2008, 312 cases who underwent the small incision extracapsular cataract extraction and intraocular lens implantation analyzed retrospectively.
RESULTS: Postoperative visual acuity increased significantly, ≥ 0.05 were in 307 cases, off blindness rate accounted for 98.4%; ≥ 0.3 were in 285 cases, and off disability rate accounted for 91.3%. Intraoperative and postoperative complications: posterior capsule rupture 4 eyes accounted for 1.3%; corneal edema 75 eyes accounted for 24.0%; iris damage 2 eyes accounted for 0.6%; temporary high intraocular pressure 5 eyes accounted for 1.6%; pupil mild deformity 6 eyes accounted for 1.9%; intraocular lens gripping 2 eyes accounted for 0.6%; postoperative uveitis 12 eyes accounted for 3.8%; withnot artificial lens implanted 5 eyes accounted for 1.6%; The average corneal astigmatism was 1.53±1.32 in the postoperative day 7, and no serious complications occurred.
CONCLUSION: Small incision cataract extraction and intraocular lens implantation has a significant effect and fewer complications, and it is safety and easy surgery, especially in primary hospital for the prevention of blindness.
KEYWORDS: cataract; small incision; extracapsular cataract extraction; intraocular lens
Jing GL, Li YL, Yue J. Clinical analysis of 312 cases small incision cataract extraction and intraocular lens implantation. Int J Ophthalmol
(Guoji Yanke Zazhi) 2010;10(9):17481749
白内障是我国首要致盲眼病，防治白内障是我国防盲致盲的重点工作，而手术是白内障复明的唯一手段。小切口白内障囊外摘除术又称小切口非超声乳化白内障摘除术，是近几年来在白内障囊外摘除基础上发展起来的白内障手术方式，它既有超声乳化手术相似的小切口和高效率的优点，又无需昂贵的超声乳化设备，被誉为“适合中国国情的白内障手术”。我们于200704/200812采用小切口白内障囊外摘除联合人工晶状体植入术治疗白内障患者312例312眼，取得了较满意的疗效，现报告如下。
1对象和方法
1.1对象
选取200704/200812我院收治的白内障患者312例312眼。男153眼，女159眼，年龄39～94(平均52)岁。术前视力：指数/眼前～0.2。其中老年性白内障263眼，先天性白内障9眼，外伤性白内障4眼，继发性白内障36眼。按Emery分级法晶状体核硬度I级11眼，II级31眼，III级228眼，Ⅳ级23眼，V级19眼。
1.2方法
常规球后麻醉或表面麻醉，作一个以上穹窿为基底的结膜瓣，止血后，于11∶00～1∶00位，角巩缘后1～2mm作反眉形巩膜隧道切口。根据核的大小，切口长约5.5～7.0mm，呈隧道分离至透明角膜内1.5～2.0mm处刺入前房，再于9∶00或3∶00位角膜缘行前房穿刺作辅助切口。前房注入黏弹剂，作连续环形撕囊或截囊，撕囊口约5～6mm左右，充分水分离，使核能在囊袋内充分游离旋转，将核的上半翘起，下半仍然位于囊袋内，通过加压切口后唇自行娩出晶状体核，较大的核块在黏弹剂保护下用注水晶状体圈匙取出。>7mm切口的核块，行双手法将晶状体核取出(将圈套器插到核的下方，插放圈套器时应该没有任何阻力，圈套器放妥后，将sinskey钩小心插到核的上方，核即夹在圈套器和sinskey钩之间，钩的尖端放在核的上方中央，这样双手操作时就能够更好的勾住核，然后双手将晶状体核取出)。冲吸净晶状体皮质，若后囊膜有皮质黏附，可用注水针头进行抛光，植入后房型人工晶状体。检查术后隧道切口是否水密，达不到水密者可缝合1针。术后给予对症抗炎治疗。
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