超声乳化联合折叠式人工晶体植入术治疗小瞳孔下白内障手术方法及疗效

Surgical method and curative effect of phacoemulsification combined with foldable intraocular lens implantation for small pupil cataract

目的探讨超声乳化联合折叠式人工晶体植入术治疗小瞳孔下白内障的手术方法及疗效。方法选取7500眼行白内障超声乳化联合人工晶体植入术患者,扩瞳后经临床确认为小瞳孔白内障者416眼。所有手术均由同一医师操作,3.0 mm三角刀经11:30角巩膜缘处作隧道长1.5 mm主切口,2:30处作辅切口,采用机械钝性分离或松解瞳孔缘的方式扩大瞳孔,行双手原位超声乳化联合折叠式人工晶体囊袋内植入术。观察临床效果。结果 416眼术前裸眼视力光感至0.3,术后第1天视力都有不同程度提高,视力≥0.5者255眼(61.3%),术后1周视力≥0.5者354眼(85.1%),术后1个月视力≥0.5者(含矫正视力)380眼(91.3%)。所有患眼术后瞳孔恢复至圆形或近似圆形,其中生理性瞳孔者278眼(67%),近似圆形者138眼(33%),患眼瞳孔对光反应存在或灵敏。术后第1天患眼经复方托吡卡胺扩瞳30min时,瞳孔均比术前有不同程度扩大,直径在5.0~6.0 mm者93眼(22%),直径≥6.0 mm者323眼(78%)。术后出现的并发症经对症处理后均消失。结论只要掌握合理的手术方法及技巧,采用个体化的手术安全参数,即使小瞳孔复杂白内障采用超声乳化手术同样可以获得优良的手术效果。术后活动自如的瞳孔给后续检查眼底及治疗后发性白内障(后发障)带来了方便,此方法值得推广。

Objective To explore the surgical method and curative effect of phacoemulsification combined with foldable intraocular lens implantation for small pupil cataract. Methods There were 7500 eyes receiving phacoemulsification combined with foldable intraocular lens implantation, and 416 eyes were clinically confirmed as small pupil cataract after pupil dilatation. All operations were performed by the same physician, with 3.0 mm triangle knife placed from sclera edge by 11：30 Angle for 1.5 mm tunnel as primary incision, and 2：30 Angle as auxiliary incision. The pupil was expanded by way of mechanical blunt separation or release the pupil edge, and combination of phacoemulsification and foldable intraocular lens implantation was performed. Clinical effect was observed. Results 416 eyes had preoperative naked eye vision light sensors 0.3, the vision increased in various degrees in postoperative 1 day, with 255 vision 1〉 0.5 eyes （61.3%）, 354 vision ≥ 0.5 eyes in postoperative 1 week （85. 1%） and 380 vision I〉 0.5 eyes in postoperative 1 month （including corrected visual acuity） （91.3%）. All pupils recovered to round or nearly round, with 278 eyes （67%） of physiological pupils and 138 eyes （33%） of round eyes. The pupil of involved eyes has reaction to light or sensitive to light. In postoperative 1 day, the pupil was enlarged to different extents after 30 min of pupil dilatation with compound tropicamide, with 93 eyes （22%） in 5.0-6.0 mm diameter, 323 eyes （78%） I〉 6.0 mm in diameter. Postoperative complications disappeared after symptomatic treatment. Conclusion As long as grasping reasonable surgical methods and techniques, and applying individual surgical safety parameters, the small pupil complex phacoemulsification surgery can also get excellent results. Postoperative ease of the pupil has brought convenience to the follow-up examination of the fundus and treatment of posterior capsular opacification. So this method is worth promoting.