微小撕囊在膨胀性白色白内障术中的应用

Application of small continuous curvilinear capsulorhexis for phacoemulsification of intumescent white cataract

目的探讨微小撕囊对提高膨胀性白色白内障超声乳化吸除术成功率的临床意义。方法 2014年2月至2015年8月收治的18例（18眼）膨胀性白色白内障患者（微小撕囊组）,与2013年1月至2014年1月收治的25例（25眼）同类疾病患者（对照组）。微小撕囊的手术方法：囊膜染色或不染色,截囊针刺破前囊膜,吸出部分乳液和皮质,做2 mm微小环形撕囊,注吸头通过撕囊口将皮质或乳糜液吸出,使囊袋内仅残留晶体核,二次撕囊直径5~5.5 mm,常规超乳。结果微小撕囊组有2例前囊膜裂开,无后囊膜破裂,连续环形撕囊成功率88.9%。术后1天,3例后弹力层略有皱襞伴角膜轻度水肿。对照组前囊膜破裂,连续环形撕囊成功率66.67%。2例后囊膜破裂,1例核块坠落,5例角膜水肿,2例眼压轻度升高。连续环形撕囊成功率微小撕囊组高于对照组,差异有统计学意义（P〈0.05）。结论微小撕囊法能显著提高膨胀性白色白内障环形撕囊的成功率,降低手术难度。

Objective To investigate the clinical significance of the small continuous curvilinear capsulorhexis in improving the success rate of the phacoemulsification of intumescent white cataract.Methods Eighteen cases（ 18 eyes） of intumescent white cataract from February,2014 to August,2015 are collected as experiment group,and 25 cases（ 25 eyes） from January,2013 to January,2014 were collected as control group.The procedure of small continuous curvilinear capsulorhexis surgery included staining or un-staining lens capsule membrane,breaking the anterior lens capsule with a discission needle,sucking out part of the emulsion and cortex,making a 2 mm tinny continuous circular capsulorhexis,and sucking the cortex or chylous fluid with a tip through the capsulorhexis opening to leave only the lens nucleus in the capsule.The diameter of the secondary capsulorhexis was 5 mm to 5. 5 mm and then conducted the conventional phacoemulsification.Results In the experimental group,only 2 cases of anterior capsule rupture were found and there was no posterior capsular rupture in any cases.CCC success rate was 88. 9%.One day after the surgery,there was descemet membrane fold in 3 cases along with light corneal edema.In contrast,we found anterior capsule rupture in 10 cases and CCC success rate is66. 67% in the control group.We found posterior capsular rupture in 2 cases,nucleus drop in 1 case,corneal edema in 5 cases,and intraocular pressure increase in 2 cases.The success rate of small continuous curvilinear capsulorhexis was higher than that of the conventional capsulorhexis（ P 〈0. 05）. Conclusion The small continuous curvilinear capsulorhexis can significantly improve the success rate of the phacoemulsification of intumescent white cataract,and make the surgery easier.