手法小切口白内障向超声乳化手术转化前的技术改进  

Technical improvement between Small incision cataract extraction and phacoemulsification

作　　者：屈伸平 南中义 余超良 

机构地区：[1]河南省西峡县人民医院眼科,474550

出　　处：《实用防盲技术》2015年第1期27-29,共3页Journal of Practical Preventing Blind

摘　　要：目的探讨手法小切口白内障如何安全向超声乳化手术过渡。方法改进手法小切口白内障手术方法对186例软核白内障实施手术,麻醉:表面麻醉加上方球结膜下浸润麻醉。切口:双切口,右上方10点方位角膜缘后1mm巩膜横行长4mm左右主切口,左上方2点方位角膜缘内1mm处作透明角膜2mm辅助穿刺口。前囊膜处理:均采用连续环形撕囊法。人工晶体植入:折叠人工晶体推注囊袋内植入。对其疗效进行评价分析总结。结果 159眼在连续环形撕囊囊袋内植入人工晶体(撕囊成功85.5%);撕囊失败27眼(14.5%),18眼在截囊、撕囊及剪囊情况下囊袋内植入人工晶体,4眼人工晶体植入睫状沟内;2眼悬韧带断裂1/4周(1.07%),行囊袋内植入人工晶体;2眼后囊破口较小睫状沟植入人工晶体;1眼后囊破裂口较大未植晶体,后囊膜破裂3眼(1.6%)。术中虹膜损伤4眼(2.1%),后弹力层脱离1眼(0.54%),皮质残留6眼(3.2%),角膜水肿、内皮混浊16眼(10.7%),术后高眼压14眼(7.5%),术后虹膜反应6眼(3.2%)。术后3天矫正视力:视力≥0.6者158眼(84.9%);0.3-0.5者19眼(10.2%);0.1-0.2者9眼(4.8%);结论改进手法小切口白内障手术方法对软核白内障进行手术,效果良好,能锻炼基层医院医生由手法小切口白内障手术向超声乳化手术过渡的基本技能,为开展超声乳化手术打下良好基础。Objetive To investigate how the small incision cataract surgery transit to phacoemulsification safely.Methods Improved small incision cataract surgery were performed on 186 cases of soft-core cataract. Anesthesia： Surface anesthesia combined with subconjunctival anesthesia. Incision： one 4mm main incision locatedin the 10：00 position sclera after 1mm of limbal and one 2mm auxiliary puncture lied in 2：00 position cornea within limbus 1 mm. Anterior capsuletreatment： Continuous Circular Capsulorhexis （CCC）. Intraocular implantation： The foldable artificial lens were implanted into the empty lens capsule. Results 159 cases （85.5%）were performed CCC successfully, and in theses cases intraocular lens（IOL） were implanted into the capsular bag. 27 cases （14.5%）were failed in performing CCC and among theses cases,18 IOLs were implanted into the capsular bag after performedthe capsulotomy ,capsulorhexis or capsule cutting, 4 IOLs were implanted in ciliary sulcus, 2 IOLs were implanted into capsular bag with 1/4 part of suspensory ligament rupture, 2 IOLs were implanted in ciliary sulcus with small rupture in posterior capsule and 1 IOL was not implanted for large rupture in posterior capsule. The other postoperative complication were as follow, iris damage in 4 cases （2.1%）, Descemet＆#39;s layer detachment in 1 case （0.54%）, cortex residue in 6 cases （3.2%）,corneal edema and corneal endothelial opacity in 16 cases（10.7%）,high intraocular pressure in 14 cases（7.5%） and iris reaction in 6 cases（3.2%）. Corrected visual acuity in postoperative 3 days： above 0.6：158 cases（84.9%）,from 0.3 to 0.5： 19 cases（10.2%）,from 0.1 to 0.2;9cases（4.8%）.Conclusion Improved small incision cataract surgery has good effect on soft-core cataract, and can help primary hospital doctors transit from small incision cataract surgery to phacoemulsfication and lay a good foundation for phacoemulsfication.

关 键 词：白内障 小切口 超声乳化 过渡 

分 类 号：R779.66[医药卫生—眼科]