表面麻醉下白内障囊外摘出术

Extracapsular lens extraction under topical anesthesia

目的 探讨表面麻醉 (简称表麻 )下白内障囊外摘出术的可行性并对其效果进行评估。方法 随机选择手术病例6 9例 78眼进行表麻下白内障囊外摘出术 ,观察麻醉效果、术中术后并发症、术后视力情况等。结果 78眼患者术中无疼痛和轻微疼痛者 75眼 (96 .15 % ) ;比较疼痛 3眼 (3.85 % ) ;无重度疼痛。术中疼痛主要发生在巩膜电凝止血、虹膜受牵引、手术结束电凝粘和结膜瓣时。手术时间在 2 5min以内 ,麻醉效果比较好。并发症 :术中后囊破裂 1例 ,术后角膜内皮局部水肿 3例。术后视力 :术后 1d ,1周及 1个月裸眼和矫正视力≥ 0 .5者分别为 6 5 .5 % ,78.5 %及 78.9% .其中后囊膜破裂患者术后随访 3个月视力达 0 .3,12例患者由于老年性黄斑变性和高度近视黄斑病变及糖尿病性视网膜病变而视力不佳。结论 表面麻醉适用于白内障囊外摘出术 ,不仅避免了球后或球周麻醉的诸多并发症而且使手术更加简单安全。

Objective To study the feasibility of extracapsular lens extraction under topical anesthesia and evaluate the effect.Methods By random selection,78 eyes of 69 patients received extracapsular lens extraction under topical anesthesia .The effects of anesthesia during surgery,complications during and after surgery and visual acuity after surgery were analyzed.Results Seventy five eyes ( 96.15% ) felt no pain or mild discomfort;Three eyes (3.85%) felt moderate pain.No patient reported severe pain.The pain during surgery was taken place mainly in electrocoagulation and iris traction.The effect of anesthesia was good in cases where surgery time was less than 25 minutes. The posterior capsules was broken in 1 case.Three cases had corneal endothelium edema.The visual acuity 0.5 or better on the first day,in the first week and the month after the operation was 65.5% , 78.5% , 78.9% ,respectively.Three months after operation,the patient whose posterior capsules was broken only reached the vision of 0.3. In the other 12 cases, visual acuity was under 0.5 due to age related macular degeneration,myopia macular degeneration and diabetic retinopathy.Conclusion Topical anesthesia applies to extracapsular lens extraction.The surgery is safe and simple due to avoiding some complications of retrobulbar or circumbulbar anesthesia. The key to the success of extracapsular lens extraction under topical anesthesia lies in mastering proficient technique and selecting appropriate patients.