后囊膜连续环形撕囊术在白内障手术中应用

Clinical application of posterior continuous curvilinear capsulorhexis in cataract operation

目的探讨白内障手术中行后囊膜连续环形撕囊预防后发性白内障的临床疗效。方法回顾性研究。选取2010年1月至2011年12月在邢台市眼科医院白内障科行白内障手术且术中行后囊膜连续环形撕囊的患者138例200只眼，随访时间14—38个月，平均随访24个月，其中儿童白内障患者28例50只眼，年龄3个月至15岁（平均2．8岁），成年白内障患者110例150只眼，年龄19至85岁（平均48．2岁），随访观察术后视力、人工晶状体眼内位置、视轴区混浊的发生情况。结果小于7岁儿童白内障患者25例45只眼，在白内障摘除过程中均一期行后囊连续环形撕囊及前部玻璃体切割术，大于7岁儿童白内障患者3例5只眼，一期行后囊连续环形撕囊术。成人白内障患者110例150只眼，均一期行后囊连续环形撕囊术。成人患者中术后裸眼视力0．2—0．4者26只眼占17．33％，0．5-0．8者92只眼占61．33％，1．0以上者32只眼占21．33％。所有儿童患者撕囊口边缘纤维化形成圆形或类圆形Soemmer—ing环，成人患者周边部前后囊膜相贴，前囊膜纤维化，后囊膜周边部不同程度混浊。138例200只眼患者均未发现人工晶状体移位，视轴光学通路清晰，无黄斑囊样水肿或视网膜脱离等手术并发症。结论一期后囊膜连续环形撕囊术用于防治后囊膜混浊疗效好，并发症少，有效防止了后发性白内障的发生，是临床用于防治后发障的有效的处理方法。

Objective To assess the clinical effect of posterior continuous curvilinear capsulorhex- is （PCCC） during cataract surgery to prevent posterior capsule opacification （PCO）. Methods Ran- domly chose and studied 138 cataract patients （200 eyes） who had experienced PCCC during cata- ract extraction from January 2010 to December 2011 retrospectively. Follow-up time was 14 to 38 months, averaged 24 months. The cataract patients included 38 children （50 eyes）, aged from 3 months to 15 year （mean 2.1 year）, and 110 adult （150 eyes）, aged from 19 to 85 year （mean 48.2 year）. The vision, location of IOL in the eye and opacification in the optical axis of post-operation were observed. Results There were 25 children cataract patients （45 eyes） whose age less than 7 years of age had experienced PCCC and anterior vitrectomy during the cataract extraction. There were 3 children cataract patients （5 eyes） who＇s age more than 7 years of age and 110 adult cata- ract patients （150 eyes）, who hand experienced PCCC during cataract phacoemulcification. Among the adult patients, there were 26 eyes （17.33%） who＇s vision was between 0.2 to 0.4, 92 eyes （61.33%） who＇s vision was between 0.5 to 0.8, also 32 eyes （21.33%） who＇s vision was or better than 1.0. In children patients, there were fibrosis capsule and round or similar round Soemmering ring in the edge of capculorhexis; in adult patients, the capsule of anterior was adhere to posterior, fibrosis in the anterior capsule, opacification could be found in the residual posterior capsule. The opacification of optical axis were not found in all the patients, and also other operative complication such as cystoid macular edema and retinal detachment and so on were not found. Conclnsions Pos- terior continuous curvilinear capsulorhexis during cataract extraction is an effective way to prevent PCO, the complication is rare, can be used to prevent PCO of post-operation.