【摘要】 目的：探讨非超声乳化小切口囊外白内障摘出人工晶状体植入术治疗老年性白内障的临床效果。方法：对40例40眼老年性白内障患者采用巩膜隧道式小切口白内障囊外摘除术，同时植入后房型人工晶状体。观察术后视力恢复、散光情况及并发症。结果：术后随访1～36mo，裸眼或矫正视力<0.5者1例(2.5%)，0.6～1.0者18例(45.0%)，1.2～1.5者21例(52.5%)。术前、术后1mo和3mo平均散光分别为(0.90±0.81)，(0.95±0.65)D和(0.93±0.60)D，术后1mo和3mo与术前比较都无显著差异(P>0.05)。主要并发症有角膜水肿、前房炎症反应。无娩核困难、后囊膜破裂、玻璃体脱出、人工晶状体植入失败和虹膜损伤等并发症。结论：小切口非超声乳化囊外白内障摘出人工晶状体植入术设备简单，操作易于掌握，切口小、创伤小、术后视力恢复良好、角膜散光小、并发症少。效果好、安全可靠、经济实惠，适于基层医院开展。
【关键词】 白内障摘出术;小切口;非超声乳化;人工晶状体;植入
Clinical observation of 40 cases of small incision nonphacoemulsification and intraocular lens implantation in senile cataractShanHou DaiDepartment of Ophthalmology, the Peoples Hospital of Wucheng County, Wucheng County 253300, Shandong Province, ChinaAbstractAIM: To explore clinical effects of the nonphacoemulsification small incision extracapsular cataract extraction and intraocular lens implantation in the treatment of senile cataract.METHODS: Forty eyes of 40 cases with senile cataract were treated with scleral tunnel incision extracapsular cataract extraction, and posterior chamber intraocular lens implantation. Postoperative visual acuity, astigmatism and complications were observed.RESULTS: With followup of 136 months, naked eye, or corrected vision was ﹤0.5 in 1 case (2.5%), 0.61.0 in 18 cases (45.0%), 1.21.5 in 21 cases (52.5%). 1 month and 3 months before and after operation, mean astigmatism was (0.90±0.81) D, (0.95±0.65) D and (0.93±0.60) D respectively and compared with the preoperative data, mean astigmatism 1 month and 3 months after operation had no significant difference (P>0.05). The major complications are corneal edema, anterior chamber inflammation. No nuclear expulsion difficulties, posterior capsule rupture, vitreous prolapse, intraocular lens implantation failure or complications such as iris damage occurred.CONCLUSION: Small incision nonphacoemulsification extracapsular cataract extraction and intraocular lens implantation need simple equipment and operation is easy to master.With small incision, less trauma, good restored visual acuity, small corneal astigmatism and few complications,it's effective, safe, reliable, affordable and suitable for primary hospital.
KEYWORDS: cataract extraction; small incision; nonphacoemulsification; intraocular lens; implantation0引言
白内障是眼科的常见病，为我国最主要的致盲眼病，白内障摘除术目前仍是治疗的主要方法。传统手术因切口大、术中术后并发症多、散光大、愈合慢、住院时间长。超声乳化吸出并后房型人工晶状体植入术白内障手术安全快捷，术后视力恢复快，疗效显著。但由于该技术要求高，设备昂贵，费用较高，一旦出现并发症多能引起严重后果[1]，在基层医疗单位难以推广普及。而小切口白内障囊外摘除术，手术切口小、视力恢复快、散光小、设备要求低、易于掌握，并且效果满意，是基层医院治疗白内障的安全、经济、有效的方法[2]。我院200701/200905对40例40眼老年性白内障患者采用了非超声乳化小切口白内障摘除及后房型人工晶状体植入术，经过临床观察，效果满意，现报道如下。
1对象和方法
1.1对象
老年性白内障患者40例40眼，其中男24例，女16例;年龄55～72(平均65)岁，均为老年性白内障;术前视力：光感～0.1者31例，0.12～0.2者9例。术前常规检查全身一般情况，术前用美国产SONOGETM测量眼轴长度，测量眼部角膜曲率，计算人工晶状体屈光度。手术显微镜为苏州产，黏弹剂采用爱维，人工晶状体为5.5～6mm国产宇宙PMMA一体式人工晶状体。根据Emery及Little的分级标准为例将核硬度分为5级，Ⅰ级核14眼，Ⅱ级核16眼，Ⅲ级核10眼。排除糖尿病视网膜病变、眼外伤、角膜病变。
1.2方法
手术均在显微镜下操作。术前充分散瞳，消毒、铺单，常规球后神经阻滞麻醉及球结膜下浸润麻醉，开睑后，作上直肌牵引缝线，于上方9∶00～12∶00为中心，作以穹窿部为基底的结膜瓣，角膜缘后2mm巩膜作弧形或反眉形切口，以隧道刀分离至透明角膜内1～2mm，以3mm的穿刺刀于隧道顶端穿刺入前房，前房及囊袋注入黏弹剂连续环形撕囊或信封式截囊，充分水分离，将核游离至前房再扩大切口至6～7mm，内切口略大于外切口，用晶状体圈匙伸入核的后方娩出晶状体核，用同轴双腔管灌吸皮质，囊袋内植入后房型人工晶状体。卡米可林缩瞳，灌吸置换出卡米可林和黏弹剂，切口不缝合或缝合1～2针，结膜下给予抗菌消炎处理，切口盖敷料，胶布固定，术毕。
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