小切口手法碎核在抗青光眼滤过术后硬核白内障手术中的疗效  

Small incision manual nucleofragmentation in the treatment of hard nucleus cataract after anti-glaucoma filtration surgery

作　　者：何自芳 李一壮[1] 秦勤[1] 陈晖[1] HE Zi-fang;LI Yi-zhuang;QIN Qin;CHEN Hui(Ninyi Eye Center,Affiliated Drum-Tower Hospital of Medical College of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院眼科,江苏省南京市210008

出　　处：《实用老年医学》2018年第9期856-858,共3页Practical Geriatrics

摘　　要：目的探讨小切口手法碎核白内障摘除联合人工晶体植入术在抗青光眼滤过术后硬核白内障手术中的有效性及安全性。方法临床检查需要手术的抗青光眼滤过术后白内障核硬度为Ⅳ~Ⅴ级的42例病人43只眼纳入研究,所有病人均在表麻下行小切口手法碎核白内障摘除联合人工晶体植入术。术后随访3个月,观察术后视力、眼压、角膜内皮细胞丢失率、滤过泡及并发症等情况,并分析手术的疗效及安全注意事项。结果术后原有滤过泡均有效保留。术中后囊膜破裂2例,未出现悬韧带离断、虹膜脱出等并发症;术后发生角膜水肿者9眼(20.9%),均未出现角膜内皮失代偿等严重并发症。病人术后第1天,视力提高34眼(79.1%);眼压较术前增高,差异有统计学意义(t=-5.498,P<0.001)。术后1周,视力提高39眼(90.7%),眼压与术前比较差异无统计学意义(t=-0.804,P=0.426);角膜内皮细胞丢失率为11.55%;角膜水肿均消退,无明显并发症。术后3个月,视力提高40眼(93.0%),眼压与术前比较差异无统计学意义(t=1.711,P=0.094);角膜内皮细胞丢失率为8.91%;无明显并发症。结论小切口手法碎核在抗青光眼滤过术后硬核白内障手术中操作灵活,能有效提高视力,且并发症较少,是一种安全可靠的方法。Objective To investigate the efficacy and safety of small incision manual nucleofragmentation combined with intraocular lens implantation in the operation of hard nucleus cataract after anti-glaucoma filtration surgery. Methods A total of 42 patients（ 43 eyes） with Ⅳ-Ⅴ nucleus cataract after glaucoma filtering surgery were enrolled in the study. Small incision manual nucleofragmentation combined with intraocular lens implantation under topical anesthesia were performed in all patients. The patients were followed up for 3 months to observe the postoperative visual acuity,intraocular pressure,corneal endothelial cell loss rate,filter bleb,complications and so on. The surgical efficacy and safety precautions were analyzed. Results After surgery,the filter bubble were effectively retained. Intraoperative posterior capsule ruptured in 2 cases,and no cases presented with suspensory ligament off,iris prolapse and other complications. Postoperative corneal edema occurred in 9 eyes（20. 9%）. One day after surgery,the visual acuity was improved in 34 eyes（79. 1%）,and the intraocular pressure was slightly higher than that before operation（t =-5. 498,P〈0. 001）. One week after surgery,the visual acuity was improved in 39 eyes（90. 7%）,and the intraocular pressure was not significantly different with that before operation（t =-0. 804,P = 0. 426）. The loss rate of corneal endothelial cell was 11. 55%,and corneal edema was subsided. Three months after surgery,the visual acuity was improved in 40 eyes（93. 0%）,and the loss rate of corneal endothelial cell was 8. 91%. Conclusions Small incision manual nucleofragmentation was a safe and reliable method in the treatment of hard nucleus cataract after antiglaucoma filtration surgery. It could improve the visual acuity effectively with few complications.

关 键 词：小切口手法碎核 抗青光眼滤过术 硬核白内障 

分 类 号：R776.1[医药卫生—眼科]