玻璃体切割系统在小瞳孔白内障手术中的应用

Application of vitrectomy in cataract surgery of small pupil

目的回顾性分析我院2010年至2012年收治的15例15眼小瞳孔白内障患者利用玻璃体切割系统中的器械辅助进行超声乳化白内障吸出+人工晶状体植入术的临床疗效。方法 15例患者中葡萄膜炎5例,青光眼术后9例,糖尿病视网膜病变1例;视力为眼前/数指～0.1。药物散瞳后瞳孔直径均<3mm,瞳孔广泛后粘连及膜状物覆盖,晶状体皮质、核黄色混浊,核硬度为Ⅱ-Ⅳ级。利用黏弹剂、眼内镊、垂直眼内剪、灌注针头、20G的玻璃体切割头等工具扩大瞳孔,再进行常规白内障超声乳化手术。术后随访3个月,观察患者视力、角膜透明度、前房闪辉、瞳孔大小及人工晶状体位置等。结果 15例患者术后1d视力:>0.3者8例,>0.5者6例,0.8者1例;术后1周视力0.5者10例,0.7者5例;术后1个月、3个月随访视力与术后1周无明显变化。术后1周15例15眼患者角膜均透明,后弹力层无皱褶,前房闪辉均为阴性。术后3个月瞳孔近圆,直径4mm左右;人工晶体位置均未见偏移。结论小瞳孔白内障超声乳化手术中充分利用手术器械,将瞳孔扩大至理想大小,术前、术后合理用药,一般均可获得良好疗效。

Objective To review the clinical effects of cataract patients with small pupil who underwent phacoemulsification surgery combined with artificial lens hnplantation, with the help of several vitrectomy surgery instruments from 2010 to 2012 in our hospital. Methods 15 patients were enrolled in this study, of which 5 cases were uveitis, 9 patients had anti-glaucoma surgery history, and 1 patient had diabetic ret- inopathy. The patients＇ preoperative visual acuity were from hand motion to 0.1. All the patients＇ pupils were less than 3 mm after cycloplegia,with posterior synechia of the i- ris and occlusion of the pupil. The nucleus of cataract were from grade ]] to grade IV. Several instruments were used to enlarge pupil, including viscoelastics, intraocular mi- croforceps,vertical intraocular scissors, syringe needle and 20G vitreous cutter, after which Phacoemulsification was performed. They were followed up for 3 months, during which patients＇ vision, corneal transparency, Tyndall sign, the size of pupil and the place of artificial lens were observed. Results At 1 day after operation, 15 patients＇ visual acuity were above 0.3,8 patients＇ visual acuity were above 0.5, and 1 patient＇ visual acuity was 0.8 ; at 1 week after operation, l0 patients＇ visual actfity were 0.5, and 5 patients＇ visual acuity were 0.7 ; the patients＇ visual acuity of one month and three months after operation had not significant difference from that of 1 week after operation. Each eye had a clear cornea at 1 week,without descemet membrane striae, and Tyndall sign was negative. The pupil was nearly round, the diameter was about 4 mm, and the artificial lens were centered. Conclusion It is very ef- fective to apply various surgical instruments in phacoemulsification to enlarge the pupils of cataract patients with small pu- pils ,and good medication are performed before and after surgery.