手法劈核人工晶状体植入治疗高度近视并发白内障疗效观察

Phacoemulsification combined with chop technique and intraocular lens implantation to treat ultra-high myopia complicated cataract

目的探讨超声乳化联合手法劈核同时植入人工晶状体治疗超高度近视并发白内障的安全有效性。方法对于2000年1月至2009年12月在淮南市晨光眼科医院收治的163例172只眼超高度近视并发白内障实施超声乳化联合手法劈核同时植入人工晶状体。术中先用超声乳化头在晶状体中央刻槽，然后将晶状体核旋至前房，以器械劈核后娩出，超声乳化吸除残余碎核，黏弹剂推注清扫后囊膜，植入适度人工晶状体，前房注吸，清除残留物。结果术后3日，视力0．3～0．6者95只眼，占55．23％，大于0．6者29只眼，占16．86％；术后1个月，视力0．3～0．6者115只眼，占66．86％，大于0．6者36只眼，占20．93％；术中3只眼发生后囊破裂（占1．74％）；术后3个月后发生视网膜脱离1只眼（占0．58％），行视网膜复位手术后视力恢复至0．1。结论使用超声乳化联合手法劈核同时植人人工晶状体治疗高度近视并发白内障，不仅可以减少术中超声乳化能量及乳化时间，从而减轻对角膜内皮的损伤，更重要的是可以减少后囊膜破裂的发生，以及晶状体核坠入玻璃体腔的危险性，提高手术的安全性。同时，低度数人工晶状体的植入可最大限度矫正屈光不正，使患者获得最佳矫正视力。

Objective To discuss the safety and efficacy of phacoemulsification combined with chop technique and intraocular lens implantation to treat ultra-high myopia complicated cataract. Methods Phacoemulsification combined with chop technique and intraocular lens implantation was done on 163 cases （172 eyes） of ultra-high myopia complicated cataract. Phaco tip was used to carve groove, then spun the nuclear to the anterior chamber, manually split the nuclear and extract- ed the nuclear, phacoemulsification broken remnants of the nuclear, injected viscoelastic agent to pol- ish the posterior capsule, implanted suitable intraocular tens, suction the anterior chamber. Results At three days after surgery, eyesight of 95 eyes was 0.3 to 0.6, which occupied 55.23%; the eye- sight of 29 eyes above 0.6 occupied 16.86%. At one month after surgery, eyesight of 115 eyes was 0.3 to 0.6, which occupied 66.86%; the eyesight of 36 eyes above 0.6 occupied 20.93%. Three cas- es occurred posterior capsule rupture intraoperatively （occupied 1.74%）. One case occurred retina de- tachrnent （occupied 0.58%） at three months postoperative, and visual acuity recovered to 0.1 after ret- inal reattachment surgery. Conclusions Using phacoemulsification combined with chop technique and intraocular lens implantation to treat ultra-high myopia complicated cataract can not only reduce the intraoperative phacoemulsification energy and duration and reduce corneal endothelium damage, but also reduce the possibility of posterior capsule rupture and the risk of lens nuclear dropping to the vitreous cavity, increase the safety of surgery. Meanwhile, the low diopter of intraocular lens im- plantation can at the maximum correct the refractive error.