表面麻醉下小切口圈垫式劈核联合折叠式人工晶状体植入术的临床效果  

Clinical efficacy of small incision chop technique with lens loop-pad and foldable intraocular lens implantation under topical anesthesia

作　　者：陈晖[1] 李一壮[1] 

机构地区：[1]南京大学医学院附属南京市鼓楼医院眼科、南京宁益眼科中心,江苏省南京市210008

出　　处：《眼科新进展》2010年第8期745-747,共3页Recent Advances in Ophthalmology

基　　金：卫生部“十一五”课题基金资助(编号:2006BAI02B04)~~

摘　　要：目的探讨表面麻醉下施行小切口圈垫式劈核联合折叠式人工晶状体植入术在老年性白内障手术中的临床效果。方法通过表面麻醉对2078例(2316眼)老年性白内障患者施行小切口圈垫式劈核联合折叠式人工晶状体植入术,记录患者手术前、后的视力,手术时间,手术前后角膜内皮细胞的密度和丢失率,患者手术前、后的散光,并观察手术并发症的发生情况。结果所有患者手术时间平均为(7.2±4.6)min,绝大多数患者术后视力较术前明显提高。术后1周患者角膜内皮细胞丢失率为(9.21±3.72)%,与术前比较,差异有显著统计学意义(P<0.001)。术前角膜平均散光度为(0.89±0.72)D,术后1周角膜平均散光度为(0.95±0.31)D,与术前比较,差异无统计学意义(P=0.066)。术中无明显不适1641眼;明显胀感630眼;19眼因过于紧张或无法合作及时补充球旁或球后麻醉。术中后囊膜破裂41眼;瞳孔缘部分撕裂33眼;巩膜隧道外口裂开22眼;悬韧带局部断裂11眼。结论采用表面麻醉施行小切口圈垫式劈核联合折叠式人工晶状体植入术不失为一种可选择的、安全、有效、简便、合理、并发症少的手术方法,熟悉手法技巧是必备条件。Objective To evaluate the clinical efficacy of small incision chop technique with lens loop-pad and foldable intraocular lens implantation under topical anesthesia for senile cataract. Methods Under topical anesthesia, small incision chop technique with self-designed lens loop-pad and foldable intraoeular lens implantation were performed on 2 316 eyes of 2 078 cases with senile cataract. Preoperative and postoperative visual acuity, operative time and astigmatism, corneal epithelial cell density and loss rate were recorded. Complications were observed. Results The average operative time was （7.2 ± 4.6） minutes. Compared with preoperative visual acuity, postoperative visual acuity was obviously improved in most patients. The loss rate of corneal endothelial cells was （9.21 ± 3.72）% at postoperative 1 week, which had obviously difference with that at pre-operation （P 〈 0.001 ）. The average preoperative corneal astigmatism was （ 0.89± 0.72 ） D, and the average corneal astigmatism was （0.95 ± 0.31 ） D at postoperative 1 week,there was no difference（P =0.066）. There were 1 641 eyes with obviously uncomfortable symptoms,630 eyes with obvious swelling, 19 eyes supplemented with periglomenflar or retrobulbar anaesthesia for nervous or noncooperation at intra-operation. There were 41 eyes with posterior capsular rupture ,33 eyes with partial pupillary margin laceration,22 eyes with external rupture of scleral tunnel and 11 eyes with collapse of topical ligamentum suspensorium. Conclusion It is suggested that the small incision chop technique with lens loop-pad and foldable intraocular lens implantation under topical anesthesia is a selective, safe, effective, simple and reliable anaesthetic way, and with fewer complications. It＇ s necessary to be familiar with operative techniques.

关 键 词：白内障摘出术 表面麻醉 小切口 人工晶状体 

分 类 号：R779.6[医药卫生—眼科]