完美超声乳化术标准的探讨

Exploration to perfect phacoemulsification

探讨完美超声乳化术的定义、标准及影响因素 ,并讨论、介绍手术技巧。“完美”的定义为术后效果与术前预计的一样 ,医生和患者都满意。标准包括 :患者无不适主诉 ;术后视功能恢复正常指标 ;角膜、房水、虹膜、瞳孔如术前 ,人工晶状体位居中 ,后囊完整、无混浊或皱褶 ;术后眼压正常。影响“完美”的因素包括患者的选择、医生的素质及医院设备。如何达到“完美” ?需要严格的术前准备、术中操作、术后用药整套的规范操作。着重介绍并探讨手术技巧 ,主张在屈光力强的力轴上做透明角膜隧道切口 ,要求切口的形状和大小标准 ,将高质量粘弹剂注入前房 ,做大小适中的正中的连续环形撕囊 ,彻底水分离后 ,以“高负压、低能量 ,多机械劈核”为原则进行超声乳化 ,对不同核硬度、不同超声乳化阶段设定不同的负压、能量、流量 。

The definition,standard of perfect phacoemulsification and the relative factors were explored,and the surgery techniques were discussed.'Perfect' means postoperative result is similar to that estimated,preoperatively and satisfied by doctors and patients.The standards of perfect include:①patients feel comfortable;②visual functions recover;③cornea,aqueous humor,iris and pupil keep to pre operative conditions;④IOL situates of center and the posterior capsule is intact and smooth;⑤IOP is normal.The factors that influence 'perfect' include patients,doctors and facility. How to achieve'perfect'?Standard manipulations are necessary for pre operative preparation,surgery manipulation and postoperative treatment.Surgical techniques mainly include:①standard clear corneal tunnel incision at the high refractive axis,②infusing high quality viscoelastic into anterior chamber and performing continuous circular central capsulorhexis,③after thorough hydrodissection,phacoemulsification with 'high vacuum,low energy and mechanical chop',which is different with the degree of cataract nucleus and the stages of surgery,④implanting anti opaque IOL,⑤using proper antibiotics and hormone after surgery.