利多卡因在超声乳化白内障手术中的散瞳效果观察

Pupil dilation with intracameral lidocaine during phacoemulsification

目的探讨前房内注射利多卡因诱导散瞳在超声乳化白内障吸除术中的应用。设计随机对照临床研究。研究对象80例(86眼)白内障患者。方法将80例(86眼)随机分为观察组34例36眼,术中前房内注射不含防腐剂的1%利多卡因诱导散瞳。对照组46例50眼,术前复方托吡卡胺滴眼散瞳。两组均进行常规超声乳化白内障吸除联合人工晶状体植入术。以消毒卡尺分别测量并记录两组患者手术开始时、前房内注射利多卡因后90秒及两组术后1、2、4、8、12、24小时的瞳孔直径。主要指标瞳孔直径。结果观察组利多卡因前房注射前及注射后90秒末瞳孔直径分别为(2.0611±0.1016)mm、(6.0972±0.1566)mm,对照组手术开始时瞳孔直径(7.6100±0.0799)mm。后两者之间有显著性差异(P=0.000)。术后2小时之内,观察组75.0%瞳孔大小恢复正常,而对照组22.0%瞳孔恢复正常;两组瞳孔恢复时间有显著性差异(P=0.000)。结论前房内注射利多卡因能快速散瞳且能显著缩短术后瞳孔恢复时间;虽然其散曈效果不如复方托吡卡胺,但多数能够满足手术需要?ㄑ劭疲?2006,15:205-208)

Objective To evaluate the efficacy of mydriasis induced by intracameral injection of 1% lidocaine instead of topical mydriatics and postoperative recovery of pupil diameter in phacoemulsification surgery through a prospectively controlled clinical trial. Design Randomized clinical trial. Participants 34 patients （36 eyes） in study group, 46 patients （50 eyes） in control group. Methods The study group comprised 34 patients （36 eyes）, who were given intracamerally 0.5 ml unpreserved lidocaine 1% without using mydriatic eyedrops preoperatively. 46 patients （50 eyes）, pupil dilated with topical mydriatics, Mydrin-p （ Tropicamid, Phenylephrine Eye Drops）, were studied for comparison. As for the study group, baseline pupil diameters were recorded before the surgery, and 90 seconds after the injection of 1% lidocaine. As for the control group pupil, diameters were recorded when the surgery began. Pupil diameters at 1h, 2h, 4h, 8h, 12h, and 24h postoperatively were recorded respectively for both groups. Corneal edema and vision recovery were recorded postoperatively. Main outcome measures Pupil diameter. Results The mean baseline pupil size of the study group was 2.0611±0.1016mm, and maximum mean pupil size obtained at 90 seconds after the injection was 6.0972±0.1566mm. At the beginning of the surgery the mean pupil diameter of the control group was 7.6100±0.799mm which was larger than 6.0972±0.1566mm （P=0.000）. 75.0% eyes in the lidocaine group returned to normal size with brisk light reflex, while only 22.0% in the control group did. The time required for return to normal pupil size was significantly different between the two groups （P=0.000）. Conclusions Intracameral injection of 1% unpreserved lidocaine can provide adequate pupil dilation and get rapid recovery of pupil size after surgery, though not as large as that of topical mydriatics for phacoemulsification. （ Ophthalmol CHN, 2006, 15： 205-208）