吲哚菁绿染色联合二次撕囊技术在成熟期白内障手术中的应用

Application of indocyanine green staining combined with secondary capsulorhexis in mature cataract surgery

目的探讨吲哚菁绿染色联合二次撕囊技术在成熟期白内障超声乳化手术中的实用性。方法取20例(20只眼)成熟期白内障患者,向前房注入0.05%吲哚菁绿稀释液行前囊膜染色,再注入粘弹剂,撕囊镊撕出一个直径约3.0 mm的小囊口,冲洗溢出的乳化皮质,再往前房注入粘弹剂,剪开囊口,撕囊镊撕除一圈囊膜条,形成大小约6 mm的囊口,常规行白内障超声乳化+人工晶体植入术。观察手术治疗效果。结果 20只眼前囊膜经0.05%吲哚菁绿染色后呈现淡绿色,撕囊时绿色囊膜与白色晶体皮质具有十分显著的绿色与白色对比,撕囊时能清晰分辨囊膜边界和撕囊方向,便于对其及时调整、控制撕囊方向。20只眼均顺利完成撕囊,并获得满意大小的囊袋口,均于囊袋内植入人工晶状体。手术结束时前房未见明显染色剂积存,侧切口处见染色剂染色。20只眼在观察期间,没有出现与染色相关的角膜内皮细胞受损、虹膜炎以及眼压异常升高等不良症状。结论吲哚菁绿染色可以有效改善前囊膜能见度,降低成熟期白内障手术的撕囊难度,二次撕囊技术可以获得大小适中的囊口,降低超乳风险,提高手术成功率。

Objective To discuss the practicability of indocyanine green staining combined with secondary capsulorhexis in the phacoemulsification of mature cataract. Methods A total of 20 patients(20 eyes) with mature cataract were injected with 0.05% indocyanine green diluent into the anterior chamber for anterior capsule staining, and then injected with viscoelastic agent. Capsulorhexis was used to tear a small capsule opening of about 3.0 mm in diameter. Wash the overflowing emulsified cortex, then inject viscoelastic agent into the anterior chamber, cut the capsule opening, and remove a circle of capsule strip with capsular forceps to form a capsule opening of about 6 mm in size, and conventional phacoemulsification + intraocular lens implantation was performed. The therapeutic effect of operation was observed. Results The anterior capsule of 20 eyes was light green after 0.05% indocyanine green staining. The green capsule and the white crystal cortex had a very significant green-to-white contrast when the capsule was torn. The boundary and direction of capsulorhexis can be clearly distinguished during capsulorhexis, so that the capsulorhexis direction can be adjusted and controlled in time. Capsulorhexis was successfully performed in 20 eyes, and a satisfactory size of the capsular bag opening was obtained. All the lenses were implanted into the capsular bag. At the end of the operation, there was no obvious staining in the anterior chamber, and staining was seen in the lateral incision. During the observation period, there was no damage of corneal endothelial cells, iritis and abnormal elevation of intraocular pressure in 20 eyes. Conclusion Indocyanine green staining can effectively improve the visibility of the anterior capsule, reduce the difficulty of capsulorhexis in mature cataract surgery, and secondary capsulorhexis can obtain the appropriate size of the capsular bag, reduce the risk of superemulsion, and improve the success rate of surgery.