外伤性白内障人工晶状体植入手术时机及方法的探讨

Discussion on time and methods for intraocular lens implantation in traumatic cataract

目的探讨外伤性白内障的手术时机的选择。方法对我院2008年7月～2011年8月收治的52例52眼外伤性白内障,根据其年龄、晶状体外伤性质、其他部位外伤情况及炎症反应程度,选择时机进行白内障摘出联合人工晶状体植入术。伴有角膜裂伤者,先缝合伤口,视情况进行一期或者二期白内障手术;晶状体囊破口较小及挫伤性白内障,待皮质浑浊较充分后进行手术;外伤后炎症反应较重者,先控制炎症,于(1-2)周内手术;晶状体皮质膨胀突出于前房接触角膜及引起严重炎症反应或继发青光眼者,则立即进行手术。采用白内障吸出、囊外摘出或玻璃体晶状体切除联合后房人工晶状体一期植入手术方法。52眼中,一期人工晶状体植入35眼,二期植入17眼,均为后房人工晶状体。结果术后视力0.05以上者占96.15%,0.3以上者占67.31%,0.5以上者占36.54%,1.0以上者占3.85%。结论正确掌握白内障的手术时机,及时处理术中术后并发症,复杂的外伤性白内障术后仍能获得较好的视力,并能促进恢复双眼单视功能。

Objective To investigate time and methods for intraocular lens implantation in traumatic cataract. Methods 52 cases（52 eyes） of traumatic cataract received cataract extraction and intraocular lens implantation（IOL） in different time according to the age, type of trauma, degree of inflammation and accompanying injuries. The wound was sutured primarily and cataract extraction was done according to the condition. For small capsule rupture or contusive cataract, the surgery was done until cortex became cloudy totally. For severe ocular inflammation, surgery was done until inflammation was controlled for 1-2 weeks. If cortex expanded, extruded and contacted with corneal endothelium or induced severe inflammation or secondary glaucoma, the surgery was done in emergency. In the 52 eyes, posterior chamber IOL implantation was done primarily in 35 eyes and 17 eyes received secondary posterior chamber IOL implantation. Results After surgery, visual acuity was 0.05 or better in 96.15% eyes, better than 0.3 in67.31% eyes, better than 0.5 in 36.54% eyes and better than 1.0 in 3.85% eyes. Conclusions For complicated traumatic cataract, with suitable surgical timing and control of intraoperative and postoperative complications, most patients could get better visual acuity and binocular vision recovery.