高度近视合并年龄相关性白内障超声乳化手术并发症处理及预防

Treatment and prevention strategies for complications of phacoemulsification in senile patients with cataract and high myopia

目的:探讨高度近视合并年龄相关性白内障患者超声乳化手术的并发症处理及预防。方法:回顾性分析研究。选取2015-01/12我院收治的高度近视合并年龄相关性白内障超声乳化手术患者90例134眼,其中男39例68眼,女51例66眼,平均年龄62.7±7.2岁,平均眼轴长度29.54±1.54(27~32)mm,术前矫正视力指数至0.5,随访6mo。观察术后1、3d,1、3、6mo的视力、眼压、裂隙灯检查,必要时进行眼底检查。结果:选取90例134眼患者术中发生后囊膜破裂7眼(5.2%),其中4眼合并玻璃体脱出(3.0%),晶状体半脱位2眼(1.5%),全脱位1眼(0.7%)。术后发生一过性高眼压9眼(6.7%),角膜水肿17眼(12.7%),视网膜脱离1眼(0.7%),均给予积极对症处理,术后视力均超过术前。随访6mo内,37眼(27.6%)患者因为视力下降就医,发生后发性白内障,予以Nd:YAG激光后囊膜切开术治疗。术中无1眼发生暴发性脉络膜上腔出血、虹膜损伤、瞳孔变形、眼内炎等严重并发症。结论:对于高度近视合并年龄相关性白内障患者尽量早期手术,术前充分检查,术中规范操作,对于术中及术后可能发生的并发症积极预防并正确处理,使患者获得更好、更舒适的视觉质量。

AIM：To explore treatment and prevention strategies for complications of phacoemulsification in senile patients with cataract and high myopia. METHODS： Cases were retrospectively analyzed. We selected 90 cases（134 eyes）, in which 39 cases（68 eyes）were males, 51 cases（66 eyes）were females, average age were 62.7±7.2. The average axial length 29.54±1.54（27-32）mm. Corrected visual acuity was finger count to 0.5. All patients were followed for 6mo. Visual acuity, intraocular pressure, slit-lamp examination were observed at 1, 3d, 1, 3 and 6mo. Fundus examination was taken too, if necessary. RESULTS： In the selected 90 patients（134 eyes）, posterior capsular rupture occurred in 7 eyes（5.2%）, including vitreous loss in 4 eyes（3.0%）, lens subluxation in 2 eyes（1.5%）, total dislocation in 1 eye（0.7%）. Transient high intraocular pressure occurred in 9 eyes（6.7%）, corneal edema in 17 eyes（12.7%）, retinal detachment in 1 eye（0.7%）, which were given symptomatic treatment actively and postoperative visual acuity became better than before. All patients were followed up for 6mo and 37 eyes（27.6%）went for doctor, because of decreased vision, posterior capsule opacification and treated through posterior capsular dissection with Nd： YAG laser. No suprachoroidad expulsive hemorrhage, iridial injury, pupil distortion, endophthalmitis and other serious complications occurred. CONCLUSION： For senile patients with cataract and high myopia, it is better to take operations as early as possible, full preoperative examination, standardized operation and be alert to intraoperative and postoperative complications, which could bring patents better outcomes.