瞳孔缘环行切除术对葡萄膜炎并发白内障术后眼前节的影响研究

Study on effect of Anterior segment after the pupillary margin circulator resection surgery on uveitis complicated cataract

目的：探讨葡萄膜炎并发的白内障处理瞳孔膜闭的较好术式。方法临床纳入40例（40眼）葡萄膜炎并发白内障瞳孔膜闭患者，随机分为两组，每组20例（20眼），分别采用瞳孔缘环行切除虹膜约0．5mm和传统机械性扩大处理瞳孔膜闭，观察术前、术后7d、1m及3m术眼最佳矫正视力、角膜、瞳孔直径、前房炎性反应。结果两组术后7天视力＞0．5者观察组占35％，对照组占15％，P＜0．05，两组比较差异有统计学意义，观察组视力优于对照组；术后自然光线下两组瞳孔状态比较，观察组瞳孔规则呈圆形、直径＜4mm者占95％、90％，对照组55％、45％，两组差异具有统计学意义；术后角膜水肿术后7天及1月两组角膜水肿程度分级比较，两者组比较差异无统计学意义；术后3d、7d房水反应 Tyndall征强阳性对照组分别占90％、55％，与观察组70％、25％差异比较差异具有统计学意义，术后1月两组房水闪辉差异比较差异无统计学意义。结论采用瞳孔缘环形切除进行瞳孔成型后瞳孔大小及形态接近正常生理状态，有效减轻术后虹膜反应，避免了瞳孔过大畏光及对视力影响，可以作为葡萄膜炎并发的白内障手术治疗的较好术式。

Objective To explore the better technique for uveitis complicated cataract with pupillary membrane closed .Methods 40 cases（40 eye）with uveitis cataract were randomly divided into 2 groups ,the ring of the pupillary margin resection and conventional mechanical to be used in two groups ,respectively ,To observe correction vision ,cornea ,pupil diameter ,aqueous humor ,anterior chamber inflammatory reaction , before surgery ,after 1 week ,1 month and 3month .Results The correction vision〉0 .5 ,after 7 days ,35% of the observation group ,15% of the control group ,P〈0 .05 ,significant difference between the two groups ,the observation group vision is better than the control group .Pupil round rules and diameter 〈 4mm of the observation group was 95% ,90% ,55% 、45% of the control group ,the two groups is statistically significant . Corneal edema grading compare the two groups showed no significant difference ,Aqueous humor flare classification comparison and Tyndall levy accounted for 90% ,55% of control group ,70% ,25% of the observation group ,the differences statistically significant difference ,3 days and 7 days after the operation . Conclusion Pupillary margin circulator resection surgery could form pupil normal size and morphology close to normal physiological state ,effectively reduce postoperative iris reaction ,avoid excessive photophobia and vision pupil ,It could be a better surgical treatment of uveitis complicated cataract .