高度近视合并白内障超声乳化及负、低度数人工晶体植入术

Phacoemulsification in myopia and negative or low powered posterior chamber intraocular lens implantation

目的探讨高度近视合并白内障超声乳化及负、低度数人工晶体植入术的临床疗效。方法总计１０２例（１２０只眼）眼轴长≥２８ｍｍ的高度近视合并白内障患者，其中Ⅱ级核５只眼，Ⅲ级核８４只眼，Ⅳ级核１６只眼，Ⅴ级核１５只眼。采用巩膜隧道式切口及原位超声乳化碎核，超声能量设定Ⅱ或Ⅲ级核为５０％～６０％，超声时间４０～１３０秒，平均７１．３秒。Ⅳ或Ⅴ级核采用超声乳化中央切核和手法出核，超声能量设定为６５％～７０％，超声时间４８～８２秒，平均６８．７秒。结果术后１个月裸眼视力≥０．５者５２只眼（４３．４％），矫正视力≥０．５者７５只眼（６２．６％）。术后随访１１～２２个月，平均１４．５个月。手术主要并发症为角膜水肿（６．７％）和后囊膜破裂（４．２％）。未见视网膜脱离及黄斑囊样水肿。结论超声乳化联合负、低度数人工晶体植入适合于高度近视合并白内障患者，具有恢复良好视功能、矫正屈光不正、预防视网膜脱离、减少后发障及手术并发症等优点。

Objective The study was designed to investigate the technique and clinical experience of phacoemulsification in myopia and negative or low powered posterior chamber intraocular lens implantation (PC IOL). Methods 120 eyes of 102 cases with myopia and cataract were included (axial length ≥28 mm) and hardness of nucleus was of grade 2 in 5 eyes, grade 3 in 84 eyes, grade 4 in 16 eyes and grade 5 in 15 eyes. Tunnel incision was made and in situ nuclear fracture technique by phacoemulsification was used. Energy and time of emulsification : 50%～60% of energy was set up and emulsification spent 40s to 2 min. 10 s (mean, 1 min. 11.3s) for nuclear sclerosis of grade 2 or 3.65%～70% of energy was set up and emulsification spent 48s to 1 min. 22s (mean, 68.7s) for cutting the central nucleus and removing the divided nucleus (grade 4 or 5). Results There were 120 eyes in this group. Eleven to 22 months after operation (mean 14.5 months) the visual acuities of 0.5 or better with and without correction were obtained in 62.6% and 43.4% respectively. The major complications were corneal edema and rupture of posterior capsule. No retinal detachment and cystoid macular edema were found.Conclusion This operation is suitable for myopia with cataract. It is worth to spread due to good visual result, proper correction of ametropia, prevention of retinal detachment, and decrease of operative complications.