改良的小切口非乳化白内障囊外摘出术千例疗效分析

Effect analysis on 1000 cases of modified small incision nonphacoemulsification extra capsular extraction

目的探讨简化改进的小切口非乳化白内障囊外摘出联合人工晶状体植入术的效果。方法1039例1039眼白内障,均为“视觉第一中国行动”国家医疗队进行手术的患者,来自边远的山区农村。术前检查视力在光感至0.15之间,无手术禁忌症者。手术均在表面麻醉下施行小切口白内障囊外摘出及后房人工晶状体植入术。结果术后第1d视力0.5以上者721眼（69.39%）,术后第2d,视力0.5以上者879眼（84.60%）;脱盲率98.94%,脱残率94.89%。术中术后并发症计有术中后囊破裂4例（0.38%）,术后明显的角膜水肿65例（6.26%）,反应性虹膜炎34（3.27%）,轻度瞳孔变形2例（0.19%）及暂时性高眼压3例（0.29%）。经治疗后均已恢复。结论小切口非乳化白内障囊外摘出人工晶状体植入术,效果与超声乳化相似,适合于当前我国国情,是白内障复明医疗队和边远农村山区基层医院首选的手术方式。

Objective To investigate the effect of improved small incision nonphacoemulsification extra capsular cataract combined intraocular lens （IOL） implantation. Methods 1039 cases（1039 eyes） of cataract were reported. All of them came from remote village and mountain areas and received surgery in the activity of＂ Vision First, China Action＂ hold by national medical team. Preoperative visual acuity was light perception to 0.15. After topical anesthesia, a fornix based conjunctival flap was done between 9-12 o＇clock and a 5.5-6.0 mm linear sclearal tunnel near limbus was made with the center of 10：30 o＇clock. Then did continuous curvilinear capsulorhexis （CCC）, hydrodissection, nucleus extraction by irrigating lens loop. After irrigating/ Aspirating remained cortex, IOL was implanted to the capsular bag. Antiinfection and antiinflammation eye drops were used daily postoperatively. Visual acuity, intraocular pressure and other ocular were done and recorded. Results According to surgical record and local hospital statistics, visual acuity was better than 0.5 in 721 eyes （69.39%） at the first postoperative day and 879 eyes（84.60%） at the second day. Visual acuity was better than 0. 05 in 98.94% eyes and than 0.3 in 94.89% eyes. Intter- and postoperative complications included posterior caspule rupture in 4 eyes（0.38%）, obvious postoperative corneal edema in 65 eyes （6.26%）, reactive irititis in 34 eyes （3.27%）, mild pupil deformation in 2 eyes （0.19%） and temporary high intraocular pressure in 3 eyes（0. 29%）. All of the complications were controlled with treatment. Conclusions Small incision nonphacoemulsification extra capsular cataract combined intraocular lens （IOL） implantation has the adavantages of small incision, sutureless, cost-effective equipments, easy learning, quick and safety, and similar effects compared with phacoemulsification, so it suitable for our county＇s condition and should be the first selection for cataract team and base hospital in the rural areas.