粘连性小瞳孔白内障手术方法的探讨

A probe in to the method of the cataract extraction and with a small pupil and synechiae.

目的 介绍一种由内源性和外源性葡萄膜炎后导致粘连性小瞳孔的白内障囊外摘出术并评价其疗效。方法 对 38例 ( 40眼 )随访 3～ 30月。手术步骤包括 :12点钟位瞳孔缘平行分离机化膜 ,后房注入透明质酸钠 ,钝性分离粘连 ,囊剪沿瞳孔缘剪除机化膜 ,下方瞳孔缘做多点状放射状切开后行白内障囊外摘出联合后房人工晶体植入术。结果 术后 40眼瞳孔基本圆形 ,38例患者视力均有不同程度提高 ,随访 3月以上视力≥0 5者 2 6例 ( 68 4% ) ,0 0 5～ 0 4者 9例 ( 2 3 6% ) ,<0 0 5者 3例( 7 9% )均为眼后段病变所致。术中未见后囊破裂 ,术后无严重并发症。结论 粘连性小瞳孔白内障采用本手术方法 ,能获得良好视力 ,而无严重并发症。

Objective To introduce a new surgical technique for cataract with a small synechia pupil,which is produced by endogenous and exogenous uveitis.Methods The statistics was recorded from 40 eyes of 38 cases and followed up for 3～30 months surgical pocedures includes paracentesis on 12 o′clock, injection of Healon in to posterior chamber,separating posterior synechiae along pupillary plane,cutting membrane,making many point cuts on inferior pupillary margin and extracapsular cataract extraction intraocular lens implantation.Results postoperation 40 eyes basically round pupil and 38 patients improved vision in some extend respectively followed up for more than three months.there are 26 cases (68.4%) obtained visual acuities≥0.5, in 9 cases (23.6%)0.05～ 0.4, in 3 case (7.9%) remain worse than 0.05, which were attributed to posterior segment abnormalities.No rupture of posterior capsule was seen in the operation and no postoperative severe complication.Conclusions These suggest methods of cataract with small synechia pupil could obtain improved vision without unacceptable risk by means of the surgical teaching mentioned.