后囊破裂的外伤性白内障手术治疗

The surgical treatment of traumatic cataract with posterior capsule rupture(PCR)

目的 探讨角膜穿孔伤伴后囊破裂的外伤性白内障手术时机、手术处理技巧和人工晶状体植入方法与原则.方法 角膜穿孔伤伴后囊破裂的外伤性白内障53例（53眼）,伤后4～11天,根据囊破裂、玻璃体视网膜等后段紊乱程度选择单纯超声乳化、晶状体皮质吸取,品状体切除联合玻璃体切除术处理后段紊乩,其中39眼（73.59%）一期植入人工晶状体,12眼（22.64%）二期植入人工晶状体.结果 术后6月矫正视力：低于0.1者3眼（5.66%）,0.1～0.25者13眼（24.53%）,0.3～0.6者28眼（52.83%）,大于0.6者9眼（16.98%）.人工晶状体偏位3眼,人工晶状体夹持2眼,人工晶状体脱位1眼.结论 角膜穿孔伤伴后囊破裂的外伤性白内障伤后应及早手术,并根据其眼前段紊乱的程度及是否伴有眼后段组织严重损害,选择适当的手术方式并适时植入人工晶状体.

Objective To investigate the timing, the technique and the principle of intraocular lens （IOL） implantation in traumatic cataract with posterior capsule rupture （PCR） in penetrating cornea injury. Methods 53 eyes of traumatic cataract with PCR in penetrating cornea injury were analyzed retrospectively. All eyes were operated with cataract surgery in 4 - 11 days after tauma. The different methods of phacoemulsification, cataract extraction, lensectomy with vitrectomy were performed according to ocular conditions. 39 eyes （39/53,73.6%） implanted IOL immediately and other 12 eyes were （ 12/59,26.4% ） secondary IOL implantation. The best corrected visual acuity （ BCVA ） , position of IOL, conditions of vitreous and retina complications of surgery were followed routinely postoperatively. Results At 6 months,BCVA were worse than 0.1 （3/53,5.6%） in 3 eyes,0. 1 -0.25 in 13 （13/53, 24. 5% ） eyes,0.3 - 0.6 in 28 （28/53,52.8%） eyes,and better than 0.6 in 9 （9/53,17.1% ） eyes. The complications were eccentric of the lens in 3 eyes,clamp of the lens in 2 eyes and subluxation of the lens in 1 eye. Conclusions Traumatic cataract with PCR in penetrating cornea injury should be operated with appropriate surgical methods in proper time after trauma according to the situation of anterior and posterior segment.