尖峰预劈核联合虹膜拉勾和囊袋张力环在晶状体不全脱位超声乳化术中应用  

Clinical applications of needle pre-chop combined with iris retractors and capsular tension ring in micro-incision phacoemulsification for lens subluxation treatment

作　　者：王志亮 陈志敏 张武林 武卫静[2] 林志辉 杨荣 

机构地区：[1]河北省眼科医院河北省眼科学重点实验室河北省眼科研究所,河北省邢台市054001 [2]邢台市人民医院

出　　处：《中国实用眼科杂志》2015年第9期1042-1046,共5页Chinese Journal of Practical Ophthalmology

基　　金：邢台市科技计划项目（2015ZC099）

摘　　要：目的 评价尖峰预劈核联合虹膜拉勾和囊袋张力环在晶状体不全脱位微切口超声乳化术中的临床应用.方法 回顾性病例研究.对2013年3月至2014年1月期间在河北省眼科医院白内障科就诊的晶状体不全脱位患者23例（25只眼）采用2.2 mm透明角膜切口,使用2～4个虹膜拉勾固定囊袋,尖峰预劈技术将晶状体核劈成4块或8块,扭动超声乳化核及吸完皮质后,囊袋内植入张力环及人工晶状体.结果 23只眼成功在囊袋内植入张力环和人工晶状体,所有患者术后3个月最佳矫正视力均较术前增加.晶状体超声乳化时间为2.3-52.6s,平均（27.6±12.6）s.灌注液消耗量为50.32～78.63 ml,平均（64.89±9.73） ml.术前角膜中央平均内皮细胞密度（2634.35±436.58）个/mm2,术后3个月角膜中央平均内皮细胞密度（2528.64±324.23）个/mm2.角膜内皮细胞丢失率为4.01％.22只眼人工晶状体偏中心量为0.00～0.63 mm,平均（0.27±0.14） mm.1只眼偏移量为2.01 mm,将囊袋张力环与巩膜缝合固定1针.2只眼人工晶状体未能植入囊袋内.所有患者均未出现囊袋收缩、眼压升高、玻璃体积血、视网膜脱离等并发症.结论 在晶状体不全脱位超声乳化术中,采用尖峰预劈技术将晶状体核劈开,可以减少前房内的操作时间,降低晶状体悬韧带进一步损伤的机会;采用虹膜拉勾固定晶状体的囊袋,可以增加术中晶状体囊袋稳定性;囊袋张力环的使用,可以增加术后囊袋及人工晶状体的居中性和稳定性。Objective To observe the clinical applications of needle pre-chop combined with iris retractors and capsular tension ring in micro-incision phacoemulsification for lens subluxation treatment.Methods Retrospective case study.This study was comprised of 25 eyes with lens subluxation.A 2.2mm clear corneal micro-incision was made.2-4 iris retractors were hooked the capsular edge to reinforce the lens capsule.The needle pre-chop technique was used to split the nucleus into 4 or 8 pieces.The capsular tension ring and the intraocular lens were implanted in the lens capsule after torsional phacoemulsification and clearing the cortex.Results The capsular tension ring and the intraocular lens were successfully implanted in 23 eyes.All patients were inproved their postoperative best corrected visual acuity after 3 months.The U/S total time： 2.3-52.6s, average （27.6±12.6） s.The ess timated fluid used（EFU） ： 50.32-78.63ml, average（64.89±9.73）ml.Preoperative average central comeal endothelial cell counts（2634.35±436.58）cells/mm2.After 3 months average central corneal endothelial cell counts（2528.64±324.23）cells/mm2.Corneal endothelial cell loss ratio 4.01%.The IOL offset of 22 eyes was 0.00-0.63mm, average（0.27±0.14）mm.But the offset of 1 eye was 2.01mm, so we sutured the capsular tension ring with the sclera.The intraocular lens were not successfully implanted in 2 eyes.No complication such as capsular contraction and increased intraocular pressure and vitreous hemorrhage and retinal detachment was occured.Conclusions The needle pre-chop technique can reduce the operation time in the anterior chamber and the opportunities of the damage of ciliary zonule.The iris retractors can hook the capsular edge to reinforce the lens capsule.The capsular tension ring was helpful for centering and stabilizing the lens capsule and IOL after the operation.

关 键 词：晶状体不全脱位 尖峰预劈核 虹膜拉勾 囊袋张力环 

分 类 号：R776.1[医药卫生—眼科]