小瞳孔白内障手术的临床体会

Experience of Cataract Surgery with Small Pupil

目的探讨小瞳孔白内障人工晶状体植入术的手术方法和效果。方法 32例(32眼)瞳孔不能散大的白内障分别采用小切口非超声乳化白内障摘出人工晶状体植入术(22例,22眼)和超声乳化吸出人工晶状体植入术(10例,10眼)。虹膜后粘连患者用粘弹剂冲洗针头分离粘连,瞳孔膜闭、瞳孔闭锁患者用维钠剪做剪切分离,必要时行瞳孔缘多点放射状小切口。Ⅱ、Ⅲ级核行超声乳化吸除及人工晶体植入手术,Ⅳ、Ⅴ级核行小切口非超声乳化摘除及人工晶体植入术,术后观察6个月。结果术后视力均较术前明显提高,≤0.04者2眼(6.25%),0.05～0.25者14眼(43.75%),0.3～0.5者16眼(50.00%)。术后瞳孔形状呈圆形者17眼,近圆形者15眼。瞳孔直径较术前扩大。结论小瞳孔白内障人工晶状体植入术手术较为复杂,病例选择、手术方式的选择、并发症的处理等是手术成功的关键因素。

Objective To evaluate the technique and effect of cataract surgery with small pupil and intraocular lens（IOL） implantation.Methods Thirty two cases（32 eyes） with adhesive small pupil cataract were selected in this study.The small incision non phacoemulsification with IOL implantation was performed in 22 cases（22 eyes）,and phacoemulsification with IOL implantation was performed in 10 cases（10 eyes）.For the patients with posterior synechia,the ophthalmic viscoelastic agent and blunt syringe needle were used to separate the adhesions;for the patients with occlusio papillae or atretopsia,the capsulotomy vannas scissors were used to the adhesive tissues,multi-minor invasive surgery was also conducted if needed.For the patients with levelⅡ and Ⅲ lens nucleus,the phacoemmulsification and intraocular lens implantation were performed;for the patients with level Ⅳ and Ⅴ lens nucleus,the small incision non-phacoemulsification and intraocular lens implantation were performed.The followed up time was 6 months.Results The postoperative visual acuities（VA） were evidently increased.VA of two eye was ≤0.04（6.25%）,of 14 eyes was 0.05-0.25（43.75%）,of 16 eyes was 0.3-0.5（50.00%）.The pupil were all return to round（17 eyes） or similar round（15 eyes）.The size of the pupil enlargered.Conclusion The cataract surgery with small pupil is more complicated.The key factors for successful surgery include the case screening,surgery opportunity and complications correcting.