白内障手术中后囊膜破裂的临床分析

Clinical analysis of posterior capsule rupture during cataract surgery

目的探讨白内障摘除人工晶状体植入术中发生晶状体后囊膜破裂的原因及处理方法。方法对625例白内障摘除人工晶状体植入术中发生晶状体后囊膜破裂的34例进行分析。结果本组白内障摘除术中晶状体后囊膜破裂的发生率为5.44%,其中有18例伴有玻璃体脱出,发生率为2.88%,后囊膜破裂伴玻璃体脱出占后囊膜破裂的52.94%.有8例破口较小,仍植入后房型人工晶状体。2例植入人工晶状体后发现人工晶状体明显偏斜移位,后将人工晶状体取出。后囊膜破裂的原因:术前降眼压不充分;上直肌吊线过紧;结膜囊过浅者睑裂撑开过大使眼内压升高;截囊口过大或悬韧带断离;娩核时切口过小或手法用力不正确;水分离不充分;注吸皮质时前房消失误吸后囊膜;注吸时前房过深、压力过大撑破后囊膜等。结论白内障摘除人工晶状体植入术中后囊膜破裂是常见的操作性并发症,与手术者手术熟练程度密切相关。如果破口不大仍可顺利植入后房型人工晶状体,如有玻璃体脱入前房,则应行前段玻璃体切除以解除瞳孔区玻璃体牵引,防止术后高眼压、黄斑囊样水肿、视网膜脱离、瞳孔重度上移等严重并发症影响术后视力。

Objective To discuss the causes and management with capsulotory loss with vitreous body deviating. Methods Analyze the 34 cases of capsulotomy loss in 625 cases of cataract extraction.Results Capsulotomy loss in cataract extraction occupies 5.44 % ,among which are 18 cases with vitreous body deviating,occupy 2.88 %. Capsulotomy loss with vitreous body deviating occupies 52.94 % of capsulotomy losso There are 8 cases with small cut implanted posterior chamber intraocular lens, two of which are found obviously dislocated and late IOL was taken out. The cause of posterior, chamber intraocular lens rupturing before operation , it is not enough to drop intraocular pressure, it is too tight the patient with shallow conjunctiva sac is widen too large in eyelid so that it tightens intraocular pressure, too large conjunctiva cut or ligament broken. It is not right to take out the lens nucleus through small cut, without right pressure, without enough water to separate lens nucleus from capsule. It is mistaken to draw posterior capsule when attracting cortex after flat anterior chamber. The pressure in anterior chamber is deep enough to break the posterior capsule ete.Conclusion Capsulotomy loss with vitreous body deviating was often postoperative complication in cataract extraction and it is close to the intimate knowledge of operator＇s skill. If the cut is not big , you could also implant the IOL. But if the hyaline body drops into anterior chamber, you should cut the preceding part of hyaline body in order to relieve the traction force of hyaline body in papillary zone in case of intraocular hypertension, cystoids macular edema, retina detachment, papillary moving upwards seriously, which are ocular complication that affects the vision after operation.