玻璃体晶状体联合手术中晶状体囊的处理

Retention of lens capsule in vitrectomy combined with lens extraction.

目的 观察玻璃体晶状体联合手术中晶状体囊不同的处理对效果的影响。方法 保留后囊组:24例晶状体超声乳化吸出术后,13例在前房注入黏弹剂及缝合角膜切口后再行玻璃体切除手术,11例未行类似处理。保留前囊组:27例经睫状体平坦部行晶状体切除术,10例在前囊中央咬切3mm的圆孔,17例保留完整前囊。结果 保留后囊组:在前房及角膜切口未行处理的病例中,4例(36％)在玻璃体切除中损伤后囊,而经过处理的病例后囊均保持完整。保留前囊组:所有病例在术后1月均出现逐渐加重的前囊浑浊,在前囊中央造孔的病例,通过小孔可窥见眼底。结论 玻璃体晶状体联合手术,前房填充黏弹剂并缝合角膜切口可以减少术中后囊的损伤;前囊中央造孔有利于术后眼底观察。

Objective To observe the effect of remaining anterior or posterior capsule with different techniques and process of vitrectomy with lens extraction . Methods (1) Posterior capsule remained group: After cataract phacoemulsification or extracapsular extraction in 24 cases, the anterior chamber and capsular bag were filled up with viscoelastics and corneal incision sutured in 13 cases and was untreated in the other 11 cases before vitrectomy .(2) Anterior capsule remained group: Lens fragmentation or lensectomy were performed in 27 cases. A 3 mm diameter opening was made by a cutting probe in the central area of anterior capsule in 10 cases among which vitreous cavity silicone oil injection was introduced in 4 cases. Anterior capsule remained intact in 17 cases including vitreous cavity silicone oil injection in 6 cases.Results (1)Posterior capsule remained group: All posterior capsule remained intact in the cases in which the anterior chamber and capsular bag were filled up with viscoelastics and corneal incision sutured before vitrectomy. Posterior capsule were ruptured by mistake cutting during the process of vitrectomy in 4 out of 11 cases in which anterior chamber, capsular bag and corneal incision were not treated. (2) Anterior capsule remained group: In the 17 cases with intact anterior capsule, anterior subcapsuler turbidness and opaque star clump at center or pericenter area were shown 1 month and 3 months after surgery respectively. In one case, a drop of silicone oil entered anterior chamber. Although the anterior capsule around the artificial hole also appeared opaque gradually, the posterior retina could be seen through the hole and no silicone oil was found in the anterior chamber. Conclusion After cataract extraction, filling the anterior chamber and capsular bag with viscoelastics and suturing corneal incision redound to anterior chamber stability and posterior capsule fixation and reduce the possibility of posterior capsule injury in subsequent vitrectomy. Making an opening in central area of anterior capsule can decrease inconvenience of retina examination caused by severe after cataract.