Ⅳ级以上硬核白内障手术方式的选择  

Choice of Operative Method on above IV grade hard nucleus cataractn

作　　者：付海涛[1] 宋磊[1] 蘑芷奄[1] 沈泽民[2] 

机构地区：[1]山东临沂市人民医院博爱眼科,山东276003 [2]上海交通大学医学院附属第三医院眼科

出　　处：《中国实用眼科杂志》2009年第12期1414-1416,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨Ⅳ级以上硬核白内障的最佳手术方式。方法选择Ⅳ级以上硬核白内障患者113例113只眼随机分为whitestar组、STORZ组和改良ECCE组，分别进行冷超声乳化白内障摘出术（38只眼）、普通超声乳化白内障摘出术（38只眼）和改良白内障囊外摘除术（37只眼），均联合人工晶状体植入术，对手术时的核处理时间、术中并发症、术后炎症反应、角膜内皮细胞丢失率及术后视力进行对比观察。结果whitestar组、STORZ组和改良ECCE组手术时间分别（13．14±4．15）min、（16．14±5．25）min、（11．85±3．24）min，P〈0．001；术后并发症及术后炎症反应以STORZ组最明显（P〈0．05）；术后1周内皮细胞丢失率，普通超生乳化组（15．12％）明显高于改良ECCE组（6．72％）（P〈0．05）；术后视力早期差别明显（P〈0．005）。结论改良ECCE具有安全、视力恢复快、并发症少的特点，是治疗Ⅳ级以上硬核白内障较理想的选择。Objective To explore the optimal operation method of the cataract with above Ⅳ grade hard nucleus. Methods The surgeries were performed on eyes of 113 patients with senile cataract above IV grade nucleus and the cases were randomly divided into three groups, the cold phacoemulsification group （Whitestar group, 38 eyes）, the general phacoemulsification group （STORZ group, 38eyes）, and the im- proved extra-capsular cataract extraction group （improved ECCE group, 37 eyes）. The improved extra-capsu- lar cataract extraction through sclera tunnel sutureless incision and two types phacoemulsification with PMMA intraocular lens implantation were performed respectively. The surgical time, operative complications, postop- erative inflammation, corneal endothelial cells and visual acuity were obtained after surgery. Results The surgical time of Whitestar group, STORZ group and improved ECCE group was 13.14± 4.15min, 16.14± 5.25min, 11.85 ± 3.24min respectively （P〈0.001）. Postoperative complications and inflammation of the STORZ group was the most obvious （P〈0.05）. The rate of the losing of corneal endothelial cells in the general phacoemulsification group （15.12%） was larger than that in the improved ECCE group （6.72%） significantly. The difference of postoperative visual acuity was obvious in early stage. Conclusions The improved extra capsular cataract extraction has many virtues of security, faster visual recovery, and less complications. It is the ideal choice for treatment of cataract with above Ⅳgrade hard nucleus.

关 键 词：白内障 超声乳化白内障吸除术 人工晶状体 

分 类 号：R776.1[医药卫生—眼科] R779.66[医药卫生—临床医学]