白内障超声乳化手术中撕囊失败的临床处理分析  

Clinical treatment of unsuccessful capsulorhexis in cataract phacoemulsification

作　　者：李俊宁[1] 何侦 林陈娟 LI Junning;HE Zhen;LIN Chenjuan(The Second People's Hospital of Beihai,Beihai 536000,China)

机构地区：[1]北海市第二人民医院眼科,广西壮族自治区北海市536000

出　　处：《中国实用眼科杂志》2018年第4期282-285,共4页Chinese Journal of Practical Ophthalmology

基　　金：北海市科技计划项目(北科合201884033)。

摘　　要：目的 探讨白内障超声乳化术中撕囊失败后手术处理的措施及效果分析。方法对23只眼白内障超声乳化术中撕囊失败后,予以临床处理的患者进行回顾性分析。结果本组23只眼,其中21只眼完成超声乳化及人工晶状体(IOL)植人术,2只眼超声乳化联合娩核及I0L植人术,术后随访3个月,视力情况:最佳矫正0.5~0.8者16只眼,1.0及以上7只眼。所有术眼植入I0L均位正,前囊口撕裂处无进一步后裂,未出现玻璃体脱出等严重并发症。术后均有不同程度角膜水肿,反应重者加强局部应用皮质类固醇,眼局部降压及维生素C静滴治疗后1周内消失。术后眼压高2只眼,予前房放液等对症处理恢复正常眼压。结论连续环形撕囊失败后,对撕裂处囊膜全面评估,采取及时有效补救,应用前房维持器(ACM)联合囊外劈核技术大部分仍可顺利安全完成超声乳化及IOL植入术,部分困难者也可联合娩核及I0L植入术均取得良好的手术效果。Objective To investigate the surgical treatment and efficiency of unsuccessful capsulorhexis in cataract phacoemulsification.Methods We analyzed the clinical treatment in 23 patients with unsuccessful capsulorhexis in cataract phacoemulsification.Results 21 eyes with phacoemulsification and IOL implantation,2 eyes with phacoemulsification,manual nuclear extraction as well as with IOL implantation.In 3months'follow-up,the best corrected visual acuity(BCVA)was 0.5--0.8 in 16 eyes,and≥1.0 in 7 eyes.All cases with IOL in position,no further tear at the capsulorhexis,and no serious complications such as vitreous prolapse happened.All patients suffered postoperative cormea edema,with one week treatment of local used corticosteroid and decrease intraocular pressure(IOP)eye drops,as well as intravenous drip of vitamin Cinjection,the symptom vanished in serious cases.In 2 eyes of postoperative high IOP,we punctured the anterior chamber and gained the normal IOP.Conclusions A overall assessment of the tearing capsule membrane in the unsuccessful capsulorhexis,the timely and effective treatment,using the anterior chamber maintainer(ACM)as well as extracapsular chopping skills,most cases could complete a safely phacoemulsifieation and IOL implantation.With complicated cases,manual nuclear extraction and IOL implantation also gained good surgical effect.

关 键 词：白内障超声乳化手术 撕囊失败 前房维持器 囊外劈核技术 

分 类 号：R77[医药卫生—眼科]