玻璃体切除术后白内障超声乳化人工晶体植入术

Phacoemulsification and intraocular lens implantation after pars plana vitrectomy

探讨玻璃体切除术后的白内障超声乳化手术的可行性、临床特点及特殊手术方法。方法 :共 2 1例患者 ( 2 1只眼 )在玻璃体切除手术 7～ 2 7个月后接受超声乳化手术 ,回顾分析其术中操作困难因素、并发症和视力结果。结果 :白内障超声乳化手术后 19只眼视力提高 ,1只眼视力无变化 ,1只眼视力降低。术中几乎在所有病例均可遇到前房深度、瞳孔直径和后囊膜位置骤然变化的情况 ,增加了手术操作的难度。术中 1只眼发生悬韧带离断。术后 18只眼出现轻度狄氏膜皱褶。结论 :虽然在玻璃体切除术后的患者群体施行超声乳化手术操作难度大、易出现并发症 ,但是经谨慎处理后绝大多数患者仍能获得良好的有用视力。

Objective:To determine the feasibility,surgical characteristics and special surgical skills of phacoemulsification in vitrectomized eyes. Methods:Phacoemusification was performed in 21 eyes who had underwent vitrectomy 7～27 months ago.Surgical difficulties,complications and visual acuity results were analyzed. Results:Postoperatively,the final best corrected visual acuity was improved in 19 eyes,not changed in 1,and worsened in 1.During phacoemulsification,sudden changes in anterior chamber depth,pupil size,and unusual mobility of posterior capsule were observed in almost all cases,which had made the procedure a challenge.Zonular dialysis was documented in 1 eye.Mild Descemet′s membrane folds presented in 18 eyes. Conclusions:Phacoemulsification in vitrectomized eyes presents more problems and complications than usual.A large portion of the patients,however,could obtain good visual acuity after delicate phacoemulsification.