初学者行扭动超声乳化白内障摘除术的临床观察

Clinical observation of torsional phacoemulsification for a beginner

目的:探讨白内障手术初学者施行扭动超声乳化技术的安全性及稳定性。方法:回顾2012-02/2013-03白内障手术初学者首次行超声乳化手术200眼的临床资料,分析手术并发症,评估术后效果。结果:术中无一眼出现前房塌陷,在最后一块核吸除瞬间后囊有轻微浪涌现象。术中出现8眼破囊,5眼行前段玻璃体切割后将人工晶状体植入睫状沟,其余3眼破口较小无玻璃体溢出,将人工晶状体植入囊袋内。1眼撕囊时裂到边缘转上级医生改行白内障囊外摘除术(ECCE)。1眼术中发现悬韧带松弛,由上级医生植入囊袋张力环后植入人工晶状体。7眼巩膜隧道切口过短,需行切口缝合。术后1wk裸眼视力:术后视力<0.05者2眼(1%),0.05～者31眼(15.5%),≥0.3者64眼(32%),≥0.5者103眼(51.5%)。术后无3级及以上角膜水肿。术后高眼压经过前房放液或局部用药后均可恢复正常。结论:白内障超声乳化手术初学者使用扭动超声乳化技术安全、有效。

AIM： To observe the clinical security of torsional phacoemulsification for a beginner. METHODS： The clinical data of 200 eyes who accepted torsional phacoemulsification by a beginner from February 2012 to March 2013 were reviewed. The operation complications were analyzed and the postoperative effect was assessed. RESULTS： There was no collapse of the anterior chamber during operation. When the last nuclear was removed the surge occurred mildly. Posterior capsular rupture happened in 8 eyes, 5 eyes intraocular lens （IOL） implanted in sclera sulcus after anterior vitrectomy, 3 eyes IOL in bag without vitreous outflow. One eye without continuous curvilinear capsulotomy was transferred to the superior doctor for extracapsular cataract extraction （ECCE）. One eye with the loose zonular fiber was implanted a capsular tension ring by the superior doctor. Seven cases need suture because of short sclera tunnel incisions. Uncorrected visual acuity a week after operation： 2 eyes （1%）0.05, 31 eyes （155%） 0.05-0.3, 64 eyes （32%） ≥0.3, 103 eyes （515%） ≥0.5. There was no grade 3 corneal edema. The high intraocular pressure can be controlled by anterior chamber penetration or drugs. CONCLUSION： The technique of torsional phacoemulsification is safe and effective for a beginner.