小切口手法碎核治疗小瞳孔硬核白内障

Clinical analysis of the scleral-tunnel small incision microcoria cataract surgery by the hard nucleus breaking technique

目的 采用巩膜隧道小切口对小瞳孔硬核白内障患者进行白内障摘除并折叠人工晶状体植入术,观察患者术后的疗效.方法 住院小瞳孔硬核白内障患者57例69只眼,均施行4mm反眉状巩膜隧道切口白内障摘除并折叠人工晶状体植入术,观察术后的视力、散光程度以及并发症等情况.结果 57例（69只眼）中,术后1个月视力0.5以上者46只眼（66.67%）,0.8以上者14只眼（20.29%）,低于0.25者4只眼（5.8%）;术前及术后1d、1周、1月测得角膜平均散光度分别为：（0.34±0.28）D、（0.41±0.32）D、（0.38±0.31）D、（0.36±0.30）D,术后各时间段角膜散光之间差异无统计学意义（P〉0.05）,与术前散光比较亦无统计学意义（P〉0.05）;术中后囊破裂5只眼（7.25%）,瞳孔缘撕裂6只眼（8.700/0）,因损伤小而没有进行处理;术后角膜内皮水肿9只眼（13.04%）、前葡萄膜炎9只眼（13.04%）、虹膜部分粘连4只眼（5.80%）、眼压增高2只眼（2.90%）,经对症治疗均7d内消失.结论 在小瞳孔硬核白内障手术中,采用巩膜隧道小切口进行白内障摘除折叠式人工晶状体植入,能有效减少手术并发症,提高手术成功率及术后疗效、降低成本,手术操作步骤简化安全,易于在白内障复明活动中推广.

Objective To discuss the effect of new method of nucleus chopping for hard nucleus that over degree Ⅳ in manual small-incision microcoria cataract surgery. Methods All 57 cases（69 eyes）with the hard nucleus of degree Ⅳ-Ⅴ had undergone manual small-incision microcoria cataract surgery with applying intratunnel nucleus chopping method that designed by the author. The vision acuity, astigmatism and complication of postoperative complication had been discussed. Results The visual acuity was ≥ 0.5 in 46 eyes （66.67%）, ≥ 0.8 in 14 eyes（20.29%）and 〈0.25 in 4 eyes（5.80%）one month after operation. After operation cornea astigmatism had none statistics difference（P〉0.05）between that of Preoperative. The complications included cornea edema（13.04%）, uveitis（13.04%）, iris accretion（5.80%）, after-cataract（5.80%）and increased tension（2.90%）. The complications diminished after symptomatic treatment in one week. Conclusions Scleral-tunnel small incision for hard nucleus in manual small incision microcoria cataract surgery is safe, simple and the less complication. It is virtue of rapid recovery, good outcome and medical expenses.