手法小切口白内障摘出人工晶状体植入术临床效果探讨

Evaluation of manual small incision cataract extraction and intraocular lens implantation

目的探讨手法小切口白内障摘出人工晶状体植入术的手术要点及临床效果。方法对1013例（1290眼）手法小切口非超声乳化无缝线门内障摘出人工晶状体植入术，采用手法注水娩核法。结果（1）1080眼采用表面麻醉，占83．72％；26眼为表面麻醉联合球结膜浸润麻醉，占2．02％；184眼为表面麻醉联合球周麻醉，占14．26％．（2）1215眼手术过程顺利，人工晶状体准确囊袋内植入，占94．19％；75眼后囊破裂，处理玻璃体后人工晶状体植入睫状沟（其中13眼行单襻或双襻缝线固定术），占5．81％。（3）术后89眼切口缝合1～3针，占6．90％。（4）视力≤0．3者87眼，占6．74％；≥0．5者1222眼，占94．73％；≥1．0者557眼，占43．18％。结论小切口非超声乳化无缝线自内障摘出人工晶状体植入术是具有良好临床效果的现代白内障摘出术式之一；灵活的麻醉方式，自闭式隧道切口，大直径撕／截除前囊及注水式娩核是手术要点；在基层医院及经济欠发达地区具有重要的防盲治盲作用及意义。

Objective To evaluate the operation points and therapeutic effects of manual small incision cataract extraction and intraocular lens implantation. Methods The surgery of manual small incision cataract extraction and intraocular lens implantation was peribrmed on 1013 cases （1290 eyes）. Use water injection to delivery nucleus. Results （1）The operation of 1080 eyes were under surface anesthesia, account for 83.72% ; the operation of 26 eyes were under surface anesthesia combined subeonjunetive anesthesia,account for 2.02% ;the operations of 184 eyes were under surface anesthesia combined peribulbar anesthesia （ 14.26% ）. The operative course of 1215 eyes was smooth,and intraocular lens were implanted accurately, account for 94. 19% ;posterior capsule rupture occurred in 75 eyes, and the IOLs were implanted in the ciliary sulcus （ single-haptie or 2-point suture fixation of IOL in 13 eyes） , account for 5.81%. （3）The incision closed with one-three ra dial suture in 89 eyes, account for 6.90% ;487 eyes got visual acuity of 〈0. 3,account for 6.74% ;that of 1222 eyes was 〉0. 5,account for 94. 73% ; that of 557 eyes was 〉 1. 0, account for 43.18%. Conclusion （1）Maunal small incision cataract extraction and intraocular lens implantation has a better clinic therapeutic effect. （2）Operation essential： many kinds of anesthesia method available for operation, tunnel incision, CCC technique in large diameter capsulotomy and use water injection to delivery nucleus. （3）In primary hospital and the undeveloped region, this operation type have significance on prevention of blindness.