白内障撕囊直径不同对后发性白内障影响的临床研究

Effect of after cataract with different size of the continuous curvilinear capsulorhexis

目的：观察连续环形撕囊口完全覆盖人工晶状体光学面与连续环形撕囊口完全不覆盖人工晶状体光学面的人工晶状体植入术后后囊膜混浊（posterior capsular opacification, PCO）的情况.方法：随访近5a来施行超声乳化吸出白内障联合人工晶状体植入手术的老年性白内障患者164例196眼,术后观察视力、撕囊口与人工晶状体光学面的关系及PCO等情况,随访12~26（平均16.3）mo.根据Sellman等的PCO分级标准进行分级：I级为没有PCO或极轻微PCO不减少红光反射,也没有珍珠样小体或IOL边缘也没有发现珍珠样小体;Ⅱ级为轻度PCO减少了红光反射,IOL边缘也没有发现珍珠样小体;Ⅲ级为在IOL区域内发现中度纤维化或珍珠样小体,但视轴（中心3mm）是透明的;Ⅳ级为重度纤维化或珍珠样小体并扩展到视轴区,并且严重减少红光反射.术后后囊膜出现Ⅱ,Ⅲ及Ⅳ级统计为临床出现后发性白内障的并发症病例.结果：后发性白内障是现代白内障摘除手术后晚期常见的并发症之一,连续环形撕囊口完全覆盖人工晶状体光学面组120眼中,发生后发性白内障42眼（35.0%）.连续环形撕囊口完全不覆盖人工晶状体光学面组76眼中,发生后发性白内障41眼（53.9%）.两组病例术后在临床后发性白内障发生率上有统计意义（P＜0.05）.结论：连续环形撕囊口大小与术后后囊膜的混浊有关.撕囊口完全覆盖人工晶状体光学面能减少后发性白内障发生的几率.

AIM ：To study the posterior capsular opacification（PCO） after implantation of foldable intraocular lens （IOL） with different size of the continuous curvilinear capsulorhexis （ccc）. METHODS： A total of 164 cases 196 eyes underwent phacoemulsification with IOL implantation. The visual acuity, relationship of capsulorhexis and IOL optic port and the incidence of PCO under different CCC after surgery were evaluated. Follow-up postoperatively for 12- 26 （average 16.3） months, the relation between two size of the CCC with PCO grade （ I-IV） after cataract surgery were studied. RESULTS： The percent of after cataract was 35.0% （42/120） in CCC with overall IOL,the CCC with no-overall IOL group was 53. 9% （41/120）. The incidence of after cataract was significant difference in the two groups. CONCLUSION： The size of the CCC is related to PCO, the CCC with overall IOL can reduce the occurrence of after cataract.