【摘要】 目的：探讨表面麻醉下行小切口非超声乳化白内障摘除及人工晶状体植入术的安全性及有效性。方法：对79例86眼白内障患者在表面麻醉下行小切口非超声乳化白内障摘除及人工晶状体植入术并观察其麻醉效果及术后视力。结果：其中64例71眼无疼痛，15例15眼胀痛，术中追加一次表面麻醉。平均手术时间为18min，术后1d及1wk视力≥0.5者分别占83%和92%。结论：表面麻醉小切口非超声乳化白内障摘除及人工晶状体植入术具有操作简单，手术时间短，术后视力恢复快且稳定，手术成本低，适合我国国情，有利于规模化手术。
【关键词】 表面麻醉;白内障摘除术;人工晶状体
Small incision nonphacoemulsification cataract extraction and IOL implantation under topical anesthesia
ZhiMin Han
Department of Ophthalmology, Taizhou Peoples Hospital, Taizhou 225300, Jiangsu Province, China
Correspondence to: ZhiMin Han. Department of Ophthalmology, Taizhou Peoples Hospital, Taizhou 225300, Jiangsu Province, China. [email protected]
Received:20100719 Accepted:20100818
Abstract
AIM: To investigate the safety and efficaty of topical anesthesia in nonphacoemutsification cataract extraction and introcular lens (IOL) implantation using small incision.
METHODS: Under topical anesthesia, small incision nonphacoemulsification cataract extraction and IOL implantation were done in 79 patients 86 eyes, and the effectiveness of topical anesthesia and postoperative visual acuity were surveyed.
RESULTS: Sixtyfour patients 71 eyes complained no pain. 15 patients 15 eyes complained distending pain, and another topical anesthetic was given during operation.The mean duration of the operation was about 18 minutes. The vision ≥0.5 was 83% (at first postoperative day)and 92%(at 1 week postoperatively) respectively.
CONCLUSION: Small incision nonphacoemulsification cataract extraction and IOL implantation under topical anesthesia is simple and spends little time. The recovery of eyesight is quick and stable. The cost of operation is very cheap. This operation has many advantages in our country.
KEYWORDS: topical anesthesia; cataract extraction; intraocular lens
Han ZM. Small incision nonphacoemulsification cataract extraction and IOL implantation under topical anesthesia. Int J Ophthalmol
(Guoji Yanke Zazhi) 2010;10(9):17531754
巩膜隧道小切口非超声乳化白内障摘除及人工晶状体植入术在经济欠发达地区成为主要术式，以往多采用球后或球周麻醉,易引发并发症，手术时间长。200809/200912我们在表面麻醉下采用巩膜隧道小切口非超声乳化白内障摘除方法完成硬性人工晶状体植入术86眼，效果满意，现报告如下。
1对象和方法
1.1对象
选取200809/200912白内障患者79例86眼，老年性白内障66眼，糖尿病并发白内障14眼，伴高度近视白内障6眼，其中男46眼，女40眼;年龄51～74岁;术前视力：光感～0.3, 手术操作时间10～26(平均18.11)min。
1.2方法
术前准备：按白内障手术常规准备积极向患者做好解释工作，消除紧张情绪，训练患者上下转动眼球，以便能更好地配合手术。术前30min口服安定2.5mg，滴复方托吡卡胺充分散瞳。麻醉方法：表面麻醉药为参天制药株式会社生产的10g/L盐酸奥布卡因滴眼液，于消毒前，放置开睑器之前共分两次滴于结膜囊内2滴/次，如术中疼痛，可加滴1～2次不等。手术步骤：放置开睑器，剪开球结膜，烧灼止血，于上方角巩膜后1mm作弦长5mm反眉弓隧道切口，颞侧透明角膜缘作侧切口，注入黏弹剂，撕囊镊连续环形撕囊。水分离后旋拔晶状体核脱入前房，注黏弹剂于核上、下，用晶状圈匙及切核刀将晶状体核切为2～3片后取出，冲洗清除残留皮质，囊袋内植入硬性人工晶状体，侧切口注水恢复眼压，切口不缝合。
2结果
麻醉效果我们将麻醉效果分为Ⅲ级。Ⅰ级：术中完全不感疼痛，手术配合良好;Ⅱ级：术中感到疼痛，加点1～2次表面麻醉药后顺利完成手术;Ⅲ级：术中疼痛，需加用球后或球周麻醉可完成手术。结果：Ⅰ级71眼(83%);Ⅱ级15眼(17%)，无1例改用球后或球周麻醉。术后视力：术后第1d≥0.5者71眼(83%)，术后1wk视力≥0.5者79眼(92%)。主要并发症：后囊破裂1眼，经处理后仍囊袋内植入人工晶状体;术后角膜内皮水肿6眼，经治疗后均在1wk消退。
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