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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(Trypanblue)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 investigate the surgical difficulties and countermeasures in phacoemulsification and white cataract surgery to reduce the complications and improve the success rate of surgery. Methods Phacoemulsification was performed in 109 white cataract patients. Intraoperative application of 0.5% indocyanine green (ICG) or 0.1% trypanblue anterior capsule (indocyanine green staining 22 eyes, trypan blue staining 87 eyes ), Making continuous circular capsulorhexis (CCC), capsulorhexis port diameter of about 4.5 ~ 5.0mm, without nucleating the lens water separation, the use of emulsified needle beveled downward bevel-down and high negative pressure pulsed ultrasound mode the lens Nuclear emulsification, suction cortex, posterior capsule after implantation of intraocular lens. Results 101 eyes were successfully completed CCC, the lens capsule phacoemulsification in the capsular bag out; 2 eyes in the Ⅲ grade CCC process there is a radial tearing mouth, the nucleus in the anterior chamber emulsion dislocation; 6 in the CCC production process There are multiple radial tearing mouth, CCC failure to expand the surgical incision, change cataract extracapsular cataract surgery. The average ultrasonic energy was 18.6% ± 5.5%, the average time of ultrasonography was 77.4 ± 35.5 seconds, and the absolute ultrasonic time was 11.9 ± 3.1 seconds. The grade Ⅳ nucleus was 68 eyes, the average ultrasonic energy was 25.7% ± 8.4% The average ultrasonic time was (100.9 ± 39.4) s and the absolute ultrasonic time was (27.6 ± 8.3) s. There were 18 eyes of grade Ⅴ, the average ultrasonic energy was 27.7% ± 10.3% ± 8.5) seconds. Posterior capsular rupture occurred in 4 eyes and intraocular lens implantation in ciliary sulcus. On the first day after surgery, some of the corneal epithelial edema occurred in 11 eyes, which regressed after 3 to 5 days. One week after surgery, the best corrected visual acuity: <0.1 in 5 eyes, 0.1 ~ <0.3 in 13 eyes, 0.3 ~ <0.5 in 15 eyes, ≥ 0.5 in 77 eyes. Conclusions White cataract has the characteristics of thin anterior capsule, fragile texture, liquefaction of the cortex, high pressure in the capsule and hard core of the lens. The manufacture of continuous circular capsulorhexis and the treatment of bare hard nucleus are the difficulties in phacoemulsification of white cataract. The CCC is facilitated by anterior capsule staining; the use of a soft-shell technique that emulsifies the needle beveled down-phantom and high-negative pulsed ultrasound mode reduces corneal endothelial cell damage; Water separation in the white cataract phacoemulsification for the prevention of posterior capsule rupture is of great significance.