双手夹持取核法在小切口非超声乳化治疗白内障中的应用

To Extract the Nucleus by Two Hands Holds Through Small Tunnel Incision with NophacoemulSification Method in Treatment of Cataract

目的探讨小切口非超声乳化双手夹持取核的方法及优点。方法对55例60只眼白内障患者,用宝石刀在角膜缘9∶30～11∶30区域做隧道切口,深约0.3mm,长约6～7mm,宽约3mm,内口比外口宽,环形撕囊,水分离晶体与囊袋,转动晶体核至前房,用注水的晶体匙和晶体调位钩双手夹持住晶体核,从隧道缓缓托出晶体核,吸出残留的晶体皮质,囊袋内植入后房型人工晶体。结果手术时间为10～15分钟,术后第一天矫正视力≥0.5者32只眼,占54%,一个月矫正视力≥1.0者42只眼,占70%。术后第一天和三个月角膜地形图检查平均散光为0.63±0.41和0.54±0.38,与术前比较无统计学差异。手术并发症为晶体后囊破裂3例,黄斑囊样水肿2例。结论小切口非超声乳化双手夹持取核法比单手托核法操作更加容易可靠,手术时间短,可避免晶体核触及角膜内皮和虹膜,不会直接引起角膜内皮和虹膜的损伤,并发症少,视力恢复快,费用较超声乳化低廉,易于为普通百姓接受。

Objective To investigate the methods and advantages of the treatment of cataract to extract the nucleus by two hands holds through small tunnel incision in nophacoemulsification method. Methods In 55 cases 60 cataract eyes, using precious stone knife to cut limbus cornea to form a tunnel at 9：30-11：30 area, about 0.3mm deep, 6-7mm long, 3mm wide, inside cut is large than outside, tear capsule in a ring shape, to separate crystal and capsule bag use salt water, to move the crystal nucleus freely, turn it to anterior chamber, use injection lens scoop and lens adjust instrument to hold crystal nucleus, to drag crystal nucleus out slowly through tunnel incision, suck off crystal cortex, to implant posterior intraocular lens. Results To waste operation times 10-15 minutes, there are 32 cases of which corrected vision was better than 0.5 in the first day after operation, occupy 54%, there are 42 cases of which corrected vision was better than 1.0 in one month after operation, occupy 70%. the first day and the third month after operation, the cornea topography show astigmatism 0.63±0.41 and 0.54±0.38 in average. There is no difference in statistics compared with before operation. The subsequent complications are posterior capsular rupture in 3 cases, macula vesicular edema in 2 cases. Conclusion The treatment methods of cataract to extract the nucleus by two hands holds through small tunnel incision in nophacoemulsification, is easier than that to use one hand to deliver the nucleus out, operation times is less, can avoid the nuclear to contact cornea endothelium and iris to damage the endothelium cells and iris, the complications is less, vision is recovery rapidly, cost is less than phacoemulsification, can be adapted for ordinary people.