复杂病例白内障超声乳化手术的难点及对策

Analysis and solution to the difficulty about phacoemulsification with intraocular lens implantation in complicated cataract

目的：观察复杂病例白内障超声乳化吸出人工晶状体植入术的疗效并探讨处理要点。方法：采用改良拦截劈裂技术对硬核白内障、高度近视并发白内障、糖尿病患者白内障及白内障合并青光眼等复杂病例白内障537例（558眼）行超声乳化手术。观察术中术后并发症及术后11TIO的最佳矫正视力。结果：术后1mo最佳矫正视力≥0．5者437眼（78．3％），0．2～0．4者92眼（16．5％），≤0．1者29眼（5．2％）；术中发生后囊膜破裂伴玻璃体脱出21眼（3．8％），晶状体核坠入玻璃体1眼（0．2％）；术后角膜水肿212眼（38．0％），无角膜失代偿；房水混浊为363眼（65．1％）；虹膜损伤2跟（0．4％）。结论：充分认识复杂病例白内障各病种的特点、正确掌握手术要点以及良好的围手术期处理，复杂病例白内障同样能获得理想的手术效果。

AIM： To evaluate the therapeutic effect of phacoe- mulsification with posterior chamber intraocular lens （ IOL） implantation and to investigate the key to the treatment of complicated cataracts. METHODS： Phacoemulsification with implantation of IOL was performed on 558 eyes of 537 cases with complicated cataracts such as hard nuclear cataract, high myopia complicated cataracts, diabetic cataract or cataract combined with glaucoma and so on through situ phacoemulsification （modified stop and chop）. Intraoperative and postoperative complications, best corrected visual acuity （BCVA） one month after sergery were observed. RESULTS： At postoperative one month, the BCVA was ≥0.5 in 437 eyes （78.3%）, 0.2 to 0.4 in 92 eyes （16.5%）, ≤ 0. 1 in 29 eyes （5. 2%）. The major complications were posterior capsule rupture （21 eyes, 3.8%）; lens nucleus into the vitreous （1 eye, 0. 2%）; corneal edema （212 eyes, 38. 0%）; flash of aqueous humor （363 eyes, 65. 1%） and iridal injury （2 eyes, 0.4%）. CONCLUSION： The character of various complicated cataracts must be understood entirely. With mastered surgery technology, carefully and skillfully perioperation, we will get well effect on complicated cataract by phacoemulsification with posterior chamber IOL implantation.