小瞳孔白内障手术中虹膜拉钩与放射状瞳孔缘虹膜切开扩瞳的并发症及视力预后对比  

The comparison about complications and vision of iris retractor and radial pupil iris incision in small pupil cataract surgery

作　　者：王水纯 吴富钞 金婷 

机构地区：[1]广州市中西医结合医院眼科,510800

出　　处：《眼科》2017年第2期85-89,共5页Ophthalmology in China

摘　　要：目的观察并对比小瞳孔白内障手术中虹膜拉钩与放射状瞳孔缘虹膜切开扩瞳的并发症及视力预后。设计回顾性比较性病例系列。研究对象2012年4月至2015年6月在广州市中西医结合医院接受超声乳化白内障吸出联合人工晶状体植入术的83例(90眼)小瞳孔白内障患者。方法 50眼行虹膜拉钩扩瞳(研究组),40眼行放射状瞳孔缘虹膜切开扩瞳(对照组),记录两组的围手术期指标、术后并发症及视力恢复情况。主要指标超声乳化时间、手术时间、术中术后并发症及术后视力。结果对照组平均超声乳化时间显著高于研究组(104.8±17.9 s和57.8±11.9 s)(t=12.835,P<0.001);对照组平均手术总时间明显低于研究组(20.1±3.8 min和29.2±5.8 min)(t=-6.468,P<0.001);对照组术中虹膜损伤及出血显著高于研究组(P<0.001);对照组术后1天矫正视力≥0.3者(40%),低于研究组(72%)(χ~2=9.328,P=0.002),对照组术后3个月矫正视力≥0.3者(80%),低于研究组(90%)(χ~2=1.798,P=0.180);研究组术后1天瞳孔变形率显著低于对照组(68%和95%)(χ~2=10.125,P=0.001);研究组术后1周瞳孔变形率显著低于对照组(20%和90%)(χ~2=46.557,P<0.001)。研究组和对照组的角膜水肿率分别为86%和90%(χ~2=0.331,P=0.565),但两组的角膜水肿程度比较,差异有统计学意义(Z=11.318,P=0.003);研究组前房反应率68%,显著低于对照组的95%(χ~2=10.125,P=0.001)。结论小瞳孔白内障手术中虹膜拉钩扩瞳,具有安全系数高、不易出血和引起炎症的优点,对术后瞳孔恢复形态和功能有积极意义。Objective To observe and compare the complications and vision of iris retractor and radial pupil iris incision in small pupil cataract surgery. Design Retrospective comparative case series. Participants Patients presented during April 2012 to June 2015 in Guangzhou Hospital of Integrated Traditional and Western Medicine accepted ultrasonic phacoemulsification combined with intraocular lens implantation for the treatment of 83 cases （90 eyes） of cataract patients. Methods 50 eyes of iris retractor in research group and 40 eyes of radial pupil iris incision in control group. The perioperative parameters, postoperative complications and visual acuity of two groups were recorded. Main Outcome Measures Ultrasound emulsification time, operation time, intraoperative and postoperative complications and postoperative visual acuity. Results The average time of phacoemulsification in control group was significantly higher than that in research group （104.8±17.9 s versus 57.8±11.9 s） （t=12.835, P〈0.001）. The control group average operation time was significantly lower than the research group （20.1±3.8 min versus 29.2±5.8 min） （t=-6.468, P〈0.001）. The patients in the control group, the rate of iris bite bleeding was significantly higher than that of study group （P〈0.001）. At post-operative 1-day, the proportion of corrected visual acuity better than 0.3 in the control group was 40%, significantly lower than 72% in the research group （χ^2=9.328, P=0.002）. At post-operative 3-month, in the control group the proportion of corrected visual acuity better than 0.3 was 80%, lower than 90% in the research group, but the difference was not statistically significant （χ^2=1.798, P=0.18）. In the research group, at post-operative 1 day, pupil deformation rate was significantly lower than the control group （68% and 95%） （χ^2=10.125, P=0.001）; and at 1 week, the pupil deformation rate was significantly lower than the control group （20% and 90%） （χ^2=46.557, P〈0.001）. The resea

关 键 词：白内障/外科学 小瞳孔 虹膜拉钩 虹膜切开 

分 类 号：R779.66[医药卫生—眼科]