白内障形态学诊断五级分类法的临床应用

Clinical application of five-class classification of cataract morphology

目的观察并评价白内障形态学诊断五级分类法在老年性白内障临床诊断和治疗中的应用效果。方法对500例（620眼）的老年性白内障采用白内障形态学诊断的五级分类法进行形态学诊断分类，分析其混浊类型和程度并选择手术和手术方式。二级以下混浊（C1，N1，P1）者多不考虑手术，二，三级混浊（C2-3,NⅡ-NⅢ，P2,-P3）者选用白内障超声乳化摘除术，对四，五级混浊（C4，NⅣ，NⅤ，P4）者选用手法碎核乳化摘除术。二，三级混浊者380眼与同期收集的160例，180眼不分混浊级别的老年性白内障行白内障超声乳化摘除术的患者作术后2～3级角膜水肿发生率的比较。结果500例（620眼，年龄56岁～86岁））的老年性白内障均完成了形态学诊断分类，显示核混浊为主者360眼占58％，后皮质混浊为主者90眼占14．5％，前皮质混浊为主者100眼占16．1％；核型白内障较多见。二级以下混浊者160眼占25．8％，二，三级混浊者380眼占61．3％，四，五级混浊者80眼占12．9％。白内障超声乳化摘除术的二，三级混浊者380眼（A组）的2～3级角膜水肿29眼发生率为7．6％，不分混浊级别的180眼（B组）的2～3级角膜水肿21眼发生率为11．7％，A组〈B组（P〈0．05）。结论白内障形态学临床诊断的五级分级法完善了白内障的临床学诊断，可判断白内障的混浊类型和程度，有利于白内障手术及手术方式的选择；选择合适的病例可减少白内障超声乳化摘除术的严重角膜并发症。

Objective To study the five-class classification of cataract morphology in clinical diagnosis. Methods The anterior cortical opacities were classified as C0C1C2C3C4 according to extent. The nuclei opacities of cataract were classified as NⅠ NⅡ NⅢ NⅣ NⅤ according to the hardness. Posterior cortical opacties were classified as P0P1P2P3P4 also according to extent. Morphological diagnosis were writed as CxNyPz, applying to the cataract clinical diagnosis. Results The five-class classification of cataract orphology is easy to application,which can estimate the morphology type of cataract as fine as the hardness of nuclei. Conclusion The clinical diagnosis of five-class classification of cataract morphology is easy to application in clinical,which can provide a reference to the cataract surgical treatment.