超声乳化白内障吸除术中晶状体核脱位的原因及处理  

Cause and management of dislocated nuclear fragments during phacoemulsification

作　　者：朱晓青[1] 魏文斌[1] 施玉英[1] 宋旭东[1] 何永奇[1] 

机构地区：[1]首都医科大学附属北京同仁医院眼科,100730

出　　处：《中华眼科杂志》2000年第2期101-103,共3页Chinese Journal of Ophthalmology

摘　　要：目的　探讨超声乳化吸除术中晶状体核脱位于玻璃体腔内的原因与处理方法。方法回顾性分析 1994年 8月至 1999年 1月在我院超声乳化白内障吸除术中晶状体核脱位于玻璃体腔内的 18例患者情况。结果　 4例脱位晶状体核悬浮在前部玻璃体中 ,扩大白内障手术切口用圈套器捞出 ;2例脱位核碎块小于核的 1/ 4,随访 3～ 4年无并发症发生 ;1例脱位核碎块约为核的 1/ 2 ,因过敏性眼内炎而最终眼球萎缩 ;11例晶状体核脱位后行玻璃体切除术 ,用过氟化碳液体将脱位核浮起后 ,其中 7例用圈套器捞出 ,2例用超声粉碎晶状体核。术后主要并发症为角膜水肿。随访 1个月至 4年 ,视力均有不同程度的提高。结论　超声乳化白内障吸除术中 ,晶状体核脱位以周边刻槽时最易发生 ,中央刻槽时次之 ,前囊裂口向后撕裂是导致晶状体核脱位的主要原因之一 ,尽早行玻璃体切除术是处理超声乳化吸除术中晶状体核脱位安全。Objective To investigate the cause and management of posteriorly dislocated lens nucleus in the vitreous cavity during phacoemulsification Methods The authors performed a retrospective study of 18 patients with dislocation of nuclear fragment into vitreous cavity during phacoemulsification at Tong Ren Hospital from August 1994 to January 1999Results 4 cases with dislocated nuclei floated in the anterior vitreous were removed by a lens loop from limbal extensive incision 2 cases with their dislocated nuclei less than 1/4 of the normal size were under followup for 3～4 years, and no complications were observed The final outcome in 1 case with a dislocated nucleus half of its normal size was ocular atrophy as a result of phacoanaphylactic endophthalmitis 11 cases underwent pars plana vitrectomy In the operation the nuclei were floated anteriorly by injection of perfluoro1,3dimethylcyclohexane, then they were removed by a lens loop through the limbus and in 2 cases they were fragmented by ultrasound The main postoperative complication was corneal edema The final visual acuities generally were improved in varying degrees in 1 month to 4 years of followup Conclusions During phacoemulsification, the dislocation of a nucleus is liable to first occur in the peripheral sculpting stage, and secondly in central sculpting stage A radial tear extending posteriorly from a discontinuous anterior capsulorrhexis is the major risk factor predisposing to posterior dislocation of the nucleus or nuclear fragment During phacoemulsification, vitrectomy should be performed as soon as possible for a nucleus dislocated into middle or posterior vitreous cavity, and it is a safe and effective method for management of dislocated nucleus

关 键 词：晶状体核脱位 白内障 超声乳化术 

分 类 号：R779.66[医药卫生—眼科]