无缝线白内障摘除术中行大直径环形撕囊治疗大硬核白内障  

Large sized continuous curvilinear capsulorhexis applied in large or hard nucleus cases in manual sutureless extracapsular cataract extraction

作　　者：曾原[1] 高建华[1] 邓江稳 

机构地区：[1]成都军区昆明总医院眼科,云南昆明650032 [2]解放军五三五医院眼科,湖南怀化418008

出　　处：《中国实用眼科杂志》2014年第5期624-626,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨以连续环行撕囊方法制作大直径前囊口在手法无缝线白内障囊外摘除术中应用于Ⅳ级以上大硬核病例的安全性及有效性。方法对2009年11月至2013年4月在怀化535医院眼科就诊的915例（1236只眼）Ⅳ级及以上大硬核自内障患者行手法无缝线白内障囊外摘除手术，术中采用连续环行撕囊法制作7～8mm直径前囊口，并对患者术中撕囊是否成功、后囊破裂、术后角膜水肿及视力等情况进行统计学分析，研究其手术价值。结果1236只眼有1221只眼（98．8％）连续撕囊成功；10只眼（0．8％）囊膜瓣向周边撕裂不能挽救，留有放射状裂口一个；5只眼（0．4％）因为虹膜后粘连、囊膜钙化机化等原因，无法常规撕囊，采用囊膜剪开及截囊等方法完成前囊开口；4只眼（0．3％）发生〈1／4象限的后囊破裂。全部病例均顺利植入人工晶状体于囊袋内。术后一过性角膜水肿22只眼（1．8％），术后2个月视力≥0．5者1038只眼（84％），≥0．3者1174只眼（95％）。结论在手法白内障术中，用连续环形撕囊制作〉常规直径的前囊口治疗大硬核病例，使手术安全性提高，值得应用。Objective To evaluate the efficacy and safety of large sized continuous curvilinear cap-sulorhexis （CCC） applied in large or hard nucleus cases in manual sutureless extracapsular cataract ex-traction. Methods All eyes with IV or V nucleus that underwent manual extracapsular cataract extrac-tions （ECCE） in which large sized continuous curvilinear capsulorhexis were performed from November 2009 to April 2013 were included in this study, the related complications such as capsule rupture, cor-neal edema and visual conditions were statistically analyzed and compared with the data of ECCEs with normal sized CCCs reported in the literature. Results Included in the study were 1236 eyes, of which 1221 eyes （98.8%） had successful CCCs up to 7-Smm in diameter, 10 eyes had a radial tear which could not be saved when performing CCC, 5 eyes had anterior capsule opened with a cysto-tome or a scissor due to capsule membrane calcification. 4 eyes （0.32%） suffered from posterior cap-sule rupture; 22 eyes （1.8%） had transient corneal edema; 1038 eyes （84%） had the visual acuity ≥ 0.5 on the 2 months postoperatively, 1174 eyes （95%） ≥0.3. The difference was statistically significant compared with the traditional ECCE （P 〈0.01）. Conclusions Large CCC technique for large or hard nucleus cases in manual sutureless ECCE is safe and reliable, of high originality and a wider range of indications so that it is worthy of application in basic medical institutions.

关 键 词：连续环形撕囊 手法无缝线白内障囊外摘除 脱核 

分 类 号：R776.1[医药卫生—眼科]