非超声乳化小切口囊外白内障摘出人工晶状体植入术分析
【摘要】 目的：分析非超声乳化小切口囊外白内障摘出人工晶状体植入术治疗白内障的疗效及并发症。方法：白内障患者90例（90眼）于9点至12点角膜缘后作6～8mm的巩膜隧道切口，撕囊或截囊后以晶状体圈匙娩出晶状体核，注吸皮质植入人工晶状体。结果: 术后3d视力：3眼0.05，66眼≥0.05～0.3，21眼视力≥0.3；术后1mo复查时视力2眼0.05，32眼 ≥0.05～0.3，56眼≥0.3。主要并发症有角膜水肿、前房炎症反应、后囊膜破裂玻璃体脱出等，2眼人工晶状体植入失败。结论：非超声乳化小切口囊外白内障摘出人工晶状体植入术设备简单易于操作，效果满意，适宜于开展白内障防盲治盲工作的需要。
【关键词】 白内障 非超声乳化小切口白内障囊外摘除 人工晶状体植入。
Non—phacoemulsification small incision extracapsular cataract extraction and intraocular lens implantation。
Abstract AIM: To evaluate the clinical effects and complications of non—phacoemulsification small incision extracapsular cataract extraction(ECCE) and intraocular lens implantation to treat cataract. METHODS: Through 6—8mm scleral tunnel incisions at 9:00—12:00, 90 cases(90 eyes) of cataracts were treated with intraocular lens implantation after continuous circular capsulorhexis or turn—on jar form to deal cataract anterior capsule and extraction of lens nucleus. RESULTS: Three days postoperatively, the visual acuity was 0.05 in 3 eyes, ≥0.05—0.3 in 66 eyes, ≥0.3 in 21 eyes; one month postoperatively, the visual acuity was 0.05 in 2 eyes, ≥0.05—0.3 in 32 eyes,≥0.3 in 56 eyes. The main complications were corneal edema, anterior chamber inflammation and posterior capsular rupture etc. Two eyes were failed to perform on intraocular lens implantation. CONCLUSION: It is simple and has satisfied effects to treat cataract that non—phacoemulsification small incision ECCE and intraocular lens implantation, and it was worth clinical promoting to prevent blindness.
· KEYWORDS: cataract; non—phacoemulsification small incision ECCE; intraocular lens implantation。
0引言。
白内障是我国致盲的首要原因，手术治疗是目前唯一有效治疗方法。作者在2006—01至新疆塔城地区某医院代职，参加当地残联组织的白内障复明工程，行非超声乳化小切口白内障囊外摘除联合人工晶状体植入治疗白内障患者90例，总结于下。
1对象和方法。
1.1对象 90例90眼中，年龄16～79（平均63）岁，男55眼，女35眼，汉族62例，维吾尔、哈萨克、回、蒙古族等少数民族28例，老年性白内障81眼，并发性白内障6眼，先天性白内障3眼。术前全身常规检查，眼部角膜曲率、A超，计算人工晶状体度数。手术显微镜为苏州产，黏弹剂采用爱维，人工晶状体为国产宇宙5.5mmPMMA一体式人工晶状体。
1.2方法 术眼常规眼科术前消毒、铺单，球后阻滞麻醉及上方球结膜下浸润麻醉。开睑后，作上直肌牵引缝线，再作以9点至12点穹窿部为基底的结膜瓣，角膜缘后2mm巩膜作弧形（反眉形）切口，约1/2巩膜厚度，板层分离巩膜隧道至角膜缘内1～2mm透明角膜，穿刺入前房，2点透明角膜作辅助切口，前房注入黏弹剂后截囊针进行开罐式截囊或连续环形撕囊，充分水分离，前房内及晶状体后注入足量的黏弹剂后使晶状体核上极部翘起并使核脱位浮于前房，再扩大切口至6～8mm，内切口略大于外切口，用晶状体圈匙伸入核的后方娩出，注吸皮质干净，黏弹剂充盈前房及使囊袋撑开，囊袋内或睫状沟固定直径5.5mmPMMA后房型人工晶状体，置换黏弹剂后前房注入消毒空气，切口视闭合情况不缝或缝合1～2针，上方球结膜下注射庆大霉素2万U、地塞米松2mg使其肿胀覆盖切口。术后处理同囊外白内障摘除术。
2结果。
2.1术后视力 除2例晶状体后囊破裂、玻璃体溢出，植入人工晶状体失败外，其余全部患者均睫状沟固定或囊袋内植入后房型人工晶状体，术后3d气泡基本吸收或不影响瞳孔区；术后3d视力：3眼0.05，66眼≥0.05～0.3，21眼视力≥0.3；术后1mo复查时视力2眼0.05，32眼 ≥0.05～0.3，56眼≥0.3。