摘要
目的探讨白色白内障超声乳化吸除术中的手术难点和处理对策,旨在减少并发症,提高手术成功率.方法对109眼白色白内障施行超声乳化手术,术中应用0.5%吲哚氰绿(ICG)或0.1%台盼蓝(Trypan blue)前囊染色(吲哚氰绿染色22眼,台盼蓝染色87眼),做连续环形撕囊(CCC),撕囊口直径约4.5～5.0mm,不做晶状体核水分离,采用乳化针头斜面朝下超声乳化(bevel-down)和高负压脉冲超声模式将晶状体核乳化吸出,吸除皮质,后囊抛光后植入人工晶体.结果 101眼成功完成CCC,于囊袋内将晶状体核乳化吸出;2眼在Ⅲ级核CCC过程中有一处放射状撕裂口,将核脱位于前房乳化吸除;6眼在CCC制作过程中有多处放射状撕裂口,CCC失败,扩大手术切口,改做白内障囊外摘除术.Ⅲ级核23眼,平均超声能量18.6%±5.5%,平均超声时间(77.4±35.5)秒,绝对超声时间(11.9±3.1)秒;Ⅳ级核68眼,平均超声能量25.7%±8.4%,平均超声时间(100.9±39.4)秒,绝对超声时间(27.6±8.3)秒;Ⅴ级核18眼,平均超声能量27.7%±10.3%,平均超声时间(155.0±79.4)秒,绝对超声时间(56.5±8.5)秒.术中4眼发生后囊膜破裂,人工晶体植入睫状沟.术后第1天,部分角膜上皮水肿11眼,于术后3～5天后消退.术后1周最佳矫正视力:＜0.1者5眼,0.1～＜0.3者13眼,0.3～＜0.5者15眼,≥0.5者77眼.结论白色白内障具有前囊膜菲薄、质地脆弱,皮质液化,囊袋内压力高,晶状体核较硬等特点.连续环形撕囊的制作和对裸露硬核的处理是白色白内障超声乳化术中的难点.通过前囊膜染色有助于CCC的制作;采用粘弹剂软壳(soft-shell)技术、乳化针头斜面朝下超声乳化和高负压脉冲超声模式,减少了角膜内皮细胞的损伤;不做水分离在白色白内障超声乳化术中对于避免后囊膜破裂有重要意义.
Objective To study the challenges and the surgical maneuvers in phacoemulsification in eyes with white cataract,aimed to reduce the complications and perform a successful operation. Methods Phacoemulsification were performed in 109 eyes with white cataract between October 2000 and January 2004.In the surgical procedure the anterior capsular was stained with 0.5% indocyanine green(ICG)in 22 eyes and with 0.1% trypan blue in 87 eyes,then continuous curvilinear capsulorhexis(CCC)was created.The diameter of CCC was about 4.5～5.0mm.Hydrodissection was avoided.The bevel-down technique and high vacuum pulse phaco mode were chosen to emulsify the nucleus,after the residual cortex removed completely,IOLs was implanted. Results CCC was completed successful in 101 eyes and emulsifying the nucleus intro-capsular;there was one radial tear in the CCC in 2 eyes,both cases have three grade of the nucleus density,first dislocated the nucleus into the anterior chamber,then phacoemulsification was performed in the anterior chamber;failure CCC with several tears was in 6 eyes and the procedure was converted to conventional extracapsular cataract extraction(ECCE).Three grade of the nucleus density were in 23 eyes,four grade of the nucleus density were in 68 eyes,five grade of the nucleus density were in 18 eyes.Its average phaco power were 18.6±5.5%,25.7±8.4%,27.7±10.3% respectively and its average phaco time were 77.4±35.5 seconds;100.9±39.4 seconds,155.0±79.4 seconds respectively and its absolute phaco time were 11.9±3.1 seconds;27.6±8.3 seconds;56.5±8.5 seconds respectively.Posterior capsular was rupture in 4 eyes and the IOLs were implanted in the sulcus.In the first day post-operation there were 11 eyes with cornea edema and the cornea became clear after 3 to 5 days.By the first postoperative week,77 eyes had a BCVA of 0.5 or better.5 eyes had a BCVA of worse then 0.1;all cases had preexisting posterior segment pathology. Conclusions The eyes with white cataracts have characteristics including thinner and brittle anterior capsular,cortex liquefaction,high intralenticular pressure and hard naked nucleus.Creating CCC and emulsification of the hard naked nucleus are the main challenges in surgical procedure.Dying anterior capsular is helpful to make a successful CCC.Aimed to reducing the damage to corneal endothelium,soft-shell technique,bevel-down technique and high vacuum pulse phaco mode should be chosen;No hydrodissection play an important role in avoiding the rupture of the posterior capsule in eyes with white cataract.
出处
《中国实用眼科杂志》
CSCD
北大核心
2005年第7期738-741,共4页
Chinese Journal of Practical Ophthalmology
