小瞳孔下超声乳化手术治疗白内障的体会

Experience on Phacoemulsification of Small Pupil Cataract

目的探讨采用透明角膜切口超声乳化白内障吸除联合折叠人工晶体植入术治疗小瞳孔白内障的临床疗效。方法对23例（26眼）小瞳孔白内障患者中通过机械性牵拉,撕除瞳孔区及瞳孔缘机化膜,放射状切开瞳孔缘,虹膜拉钩机械牵拉方式扩大瞳孔,采用透明角膜切口超声乳化白内障吸除联合折叠人工晶体植入术,术后随访1~3个月对视力、眼压、术后瞳孔情况、术后并发症进行临床观察。结果本组患者88.46%患者术后最佳矫正视力达0.1以上,术后瞳孔圆形或接近圆形,术后角膜轻度水肿3眼（占11.53%）,1周内消退,1周后虹膜不同程度后粘连2眼（占7.69%）,后发障有2眼（占7.69%）。术中撕开瞳孔区机化膜发现晶状体无混浊1例,术后患者第1日前房炎症反应较正常眼有所加重,无虹膜损伤、后囊破裂,角膜内皮失代偿及晶体核坠落入玻璃体腔等严重并发症的发生。结论采用透明角膜切口对小瞳孔下白内障患者进行超声乳化白内障吸除联合折叠人工晶体植入手术是理想的手术方式,有效地提高了患者的视力,最大限度的维持了瞳孔的生理功能,同时减少了并发症的发生。

Objective To study the clinical effect of phacoemulsification and intraocular lens implantation with clear corneal incision through small pupil. Methods The study comprised 23 patiens（ 26 eyes）,a variety of mydriatic medications,including stretch pupilloplasty,a removal of the fibrotic papillary edge,multiple radial sphincterotomies,iris retractors were engaged in order to enlarge the narrow pupils to undergo phacoemulisification with IOL implantation by a single surgeon. The patients were followed up. 1 ~ 3 months. Postoperative outcome included best- corrected visual acuity,IOP,the size of pupil and complications. Results 88. 46 percent of the patients’ BCVA improved to ＆gt; 20 /200,the pupils are round or nearly round,corneal edema in 3 eyes,which disappeared in 1 week,posterior synechia of the iris in 2 eyes after 1 week（ 7. 69%）,posterior capsule opacification in 2 eyes（ 7. 69%）. transparent lens after the resection of pupillary organization membrane in 1 eye,the anterior chamber inflammation is more significant than the other normal eye on the first day after the surgery,but no such severe complications as iris emulsification and damage,posterior capsule rupture and decompensation of corneal endothelium were documented. Conclusions The phacoemulsification and intraocular lens implantation with clear corneal incision in microcoria cataract is a ideal mode of operation,it can improve eyesight of patients effectively,achieve the function of pupil up to the hit and reduce the complications as well.