二次撕囊术在白内障超声乳化摘除及人工晶状体植入术中的应用

目的 :探讨在白内障超声乳化摘除及人工晶状体植入术中行二次撕囊术 (secondarycapsulorhexis)的方法和作用。方法 :对 6例因皮质膨胀或液化眼行计划性的二次撕囊 ;10例行非计划性的二次撕囊 ,其中 3例因撕囊口过小难于植入囊袋内位固定人工晶状体 ,3例因超声乳化白内障摘除时前囊膜切迹破裂 ,4例因撕囊口偏中心 ,为防止囊膜收缩综合征发生以致遮盖瞳孔区而行二次撕囊。结果 :二次撕囊术后完成前囊膜连续曲线形撕囊 13眼 ,16眼均植入囊袋内位固定人工晶状体。结论 :二次撕囊术可使晶状体皮质膨胀或液化的白内障眼易于完成前囊膜连续曲线形撕囊 ;可避免白内障术中前囊膜切迹破裂以至进一步放射状撕裂 ;可维持完整曲线形撕囊口边缘 ,防止发生人工晶状体植入后光学部偏中心 ,囊襻异位 ;使过小撕囊口易于植入囊袋内位固定人工晶状体 ;使撕囊口偏下而让难于被吸除的上方赤道部残收稿日期 :2 0 0 2 -0 3 -2 6;修回日期 :2 0 0 2 -0 6-0 4作者简介 :周坚强 ( 1973 -) ,男 ,嘉兴人 ,眼科医师。通信作者 :周坚强 (E -mail:zhjq @mail.jxptt.zj.cn)。余皮质易于被吸除 ;可减少或避免过小前囊膜撕囊口或明显偏中心撕囊口发生囊膜收缩综合征 (capsulecontractionsyn drome)等。     

白内障术中后囊膜破裂行后囊膜连续曲线形撕囊术

目的：讨论白内障囊外摘除、超声乳化摘除及针吸摘除术中后囊膜破裂时行后囊膜连续曲线形撕囊术（ｐｏｓｔｅｒｉｏｒ ｃｏｎｔｉｎｕｏｕｓ ｃｕｒｖｉｌｉｎｅａｒ ｃａｐｓｕｌｏｒｈｅｘｉｓ,ＰＣＣＣ）的方法和作用。方法：利用撕囊镊对１０例（１０眼）白内障摘除术中后囊膜破裂眼行ＰＣＣＣ,５例联合行前段玻璃体切除术。结果：１０例后囊膜破裂后行ＰＣＣＣ眼９例成功完成ＰＣＣＣ,１ 均植入后房人工晶体。术后观察１月～３年（平均１６月）,９例行ＰＣＣＣ眼视轴均清晰,未发生视网脱离及后发性白内障,无明显的人工晶体光学部偏中心或人工晶体异位。结论：ＰＣＣＣ可有效避免后囊膜破孔进一步无限放射状撕裂,保持周边后囊膜的完整性。使人工晶体稳固于囊袋内。     

Suction posterior capsulorhexis.

A technique for creating a posterior capsulorhexis during phacoemulsification is presented. It can be used in cases with posterior capsule tears or opacities. The free edge of the capsule is grasped with suction using a 2 mL syringe and a 27 gauge Rycroft cannula introduced via the paracentesis. The edge is then manipulated to produce a continuous curvilinear opening in the posterior capsule. The combination of a closed eye plus the use of a viscoelastic agent in the anterior chamber and capsular bag minimizes the possibility of vitreous prolapse during the maneuver. Occlusion of the cannula tip by the posterior capsule reduces the risk of vitreous aspiration. In-the-bag intraocular lens implantation is readily achieved.     

选择性后房型人工晶状体植入前的后环形撕囊术

目的：探讨后囊膜增殖钙化的白内障摘出术后的后囊膜处理技术。方法：对42例(49只眼)后囊膜增殖钙化的白内障患者，于摘除白内障后在后囊膜旁中心处用破囊针头划出起始瓣，沿起始瓣边缘撕开一直径约3～4mm的类圆孔，再植入人工晶状体。结果：全部术眼后囊膜中央均有一透明类圆孔，术后无人工晶状体偏位或眼底异常改变。结论：后房型人工晶状体植入前的后环形撕囊术可使后囊膜增殖钙化的白内障获得视轴透明区，是安全有效地处置后囊膜混浊方法之一。     

白内障手术中后囊硬性斑的处理

目的：探讨白内障患者后囊“硬性斑”的诊断及处理方法。方法：根据术前裂隙灯检查和手术中证实硬性斑的不同情况，选择后囊处理方式；首选“oerHi”环形撕囊仪环形撕囊，次之选用刺开撕囊，特殊的硬性斑用不同的环形切囊法。结果：oerHi环形撕囊仪5眼无1眼出现玻璃体溢出晶状体囊袋内，而刺开撕囊2眼有1眼玻璃体溢出晶状体囊袋内、环形切囊2眼均出现玻璃体溢出晶状体囊袋内，给予前段玻璃体切除，本组9眼人工晶状体均植入晶状体囊袋内。结论：用oerHi环形撕囊仪环形撕后囊“硬性斑”，安全、简便。刺开撕囊时，勿伤及玻璃体前膜，深度掌握有难度，环形撕囊时需做前段玻璃体切除准备。     

后囊膜混浊的先天性白内障术中的连续线形撕后囊术

目的研究后囊膜混浊的先天性白内障摘除术后的后囊膜处理方法。方法在３２只眼后囊膜混浊的先天性白内障中，摘除白内障及植入人工晶体后于后囊膜的旁中心作一穿刺孔，然后向后囊膜与玻璃体前界膜的间隙注入Ｈｅａｌｏｎ，再沿后囊膜穿刺孔边缘线形撕开一个直径约４ｍｍ的圆孔。结果全部术眼后囊膜中央有一透明裂孔，２只眼玻璃体溢出，术后未见人工晶体移位。结论连续线形撕后囊术可使后囊膜混浊的先天性白内障获得视轴透明区，并保持周边囊袋的完整性。     

白内障截囊方式对后囊浑浊影响的调查分析

目的 分析不同截囊方式对后囊浑浊的影响。方法 回顾259眼以开罐式截囊、信封式截囊和连续环形撕囊3种方式截囊的白内障囊外摘出术后后囊浑浊的情况。结果 随访1年，开罐式截囊87眼术后发生后囊浑浊22眼（25.3%)；信封式截囊82眼术后发生后囊浑浊19眼（23.2%)；连续环形撕囊90眼术后发生后囊浑浊8眼（8.9%)。连续环形撕囊组后囊浑浊的发生率与其它两组有显著性差异（P＜0.05)。结论 连续环形撕囊有利于降低后囊浑浊的发生。     

Capsular block syndrome associated with horizontal jerk nystagmus

A 78-year-old cataract patient with horizontal jerk nystagmus had phacoemulsification and intraocular lens (IOL) implantation in the capsular bag with continuous curvilinear capsulorhexis. One week postoperatively, the posterior capsule ballooned posteriorly, the anterior capsule opening was sealed to the IOL optic, and a transparent liquefied substance accumulated between the lens optic and the posterior capsule. The best corrected visual acuity was 0.6 with a myopic shift compared with the refraction after the first day. A neodymium:YAG laser posterior capsulotomy was performed, and the capsular block syndrome (CBS) resolved. The results confirm the experimental model proposed by Zacharias suggesting that saccadic eye movements contribute to CBS under certain anatomic conditions.     

囊袋减张辅助吲哚菁绿前囊膜染色在白色膨胀期白内障中的应用

目的　对比观察白色膨胀期白内障手术中囊袋减张辅助吲哚菁绿前囊膜染色的临床应用效果。方法　收集2018年1月至7月于大连市第三人民医院白内障中心行白内障超声乳化摘出联合人工晶状体植入术的白色膨胀期白内障患者90 例（90眼）,依据手术方式不同分为2组,A组45例（45眼）采用囊袋减张撕囊法辅助吲哚菁绿前囊膜染色,B组45例（45眼）采用单纯吲哚菁绿前囊膜染色连续环形撕囊术。记录两组术后1 d、7 d、1个月、3个月的最佳矫正视力（best corrected visual acuity,BCVA）、角膜内皮细胞密度（corneal endothelial denisty,CED）差值,并统计术中术后并发症发生情况。结果　术后1 d、7 d、1个月及3个月患者的BCVA和CED差值两组间相比,差异均无统计学意义（均为P＞0.05）。术中,B组有12例撕囊直径未达到5.0 mm,17例撕囊不连续,8例后囊膜破裂及玻璃体溢出;A组发生上述并发症者各有1例。术后,A组1例囊袋收缩,2例后囊膜皱褶,3例BCVA远视化;B组7例囊袋收缩,8例后囊膜皱褶,10例BCVA远视化。结论　白色膨胀期白内障术中采用囊袋减张辅助吲哚菁绿前囊膜染色安全、有效,并发症少。     

高度近视眼白内障术中Ⅰ期后囊膜连续环形撕除术

目的 探讨I期后囊膜连续环形撕除术(Posterior continuous curvilinear capsulorhexis,PCCC)对高度近视眼白内障术后后发障的预防作用.方法 对203例(211只眼)高度近视眼白内障行白内障超声乳化及人工晶状体植入术,其中70只眼术中行连续环形撕除后囊(A组),植入普通聚甲基丙烯酸甲酯(PMMA)人工晶状体;非PCCC组138只眼进一步分为普通PMMA人工晶状体组(B组)73只眼,光学部边缘直角设计的折叠人工晶状体组(C组)68只眼.B组和C组单纯行白内障超声乳化及人工晶状体植入术,保留完整后囊膜.所有患眼术后随访2年以上,观察术后后发障、视网膜脱离等并发症情况. 结果 A组2只眼(2.86%)发生了后发障,B组为18只眼(24.66%),C组8只眼(11.76%),两两对比差异显著具有统计学意义(P＜0.05);A组和C组无视网膜脱离发生,B组仅1只眼发生视网膜脱离. 结论 I期后囊膜连续环形撕除术安全有效,明显减少了高度近视眼白内障术后后发障的发生.     

Influence of intraoperative complication on intraocular rigid lens fixation in pediatric cataract surgery

PURPOSE: This paper presents the intraoperative complications in pediatric cataract surgery with IOL implantation and their influence on fixation place. MATERIAL AND METHODS: 384 eyes of 276 children undergone operative procedure for cataract. Anterior capsulorhexis, lens cortical aspiration, primary posterior capsulorhexis with anterior vitrectomy and IOL implantation were done in all eyes. The place of IOL implantation was capsular sac or ciliary sulcus. RESULTS: There were no serious intraoperative complications but in cases with large anterior (5.2%) and posterior (14.6%) radial capsule tears, vitreous loss (12.3%), and hemorrhage (5.5%) to anterior and posterior chamber the IOL was fixated at ciliary sulcus (in 37.5%). CONCLUSIONS: The surgical procedure is useful and safe in the management of pediatric cataract. Location of an IOL in the ciliary sulcus in a child, is acceptable. To avoid decentration in this cases, we recommend rigid PMMA IOLs.     

后囊连续环形撕囊在防治儿童人工晶状体植入术后后囊混浊中的作用

目的 探讨后囊连续环形撕囊在预防儿童白内障人工晶状体植入术后后囊混浊中的作用。方法 对29例29眼儿童白内障在植入人工晶状体后行一期后囊环形撕囊，术后随访3个月－2a。结果 术后随访显示27眼获得视轴透明区，眼底可见，矫正视力均有不同程度的提高。结论 一期后囊连续环形撕囊是预防儿童白内障人工晶状体植入术后后囊混浊的可行方法。     

Capsular block syndrome with external blockage of the capsular opening by a ciliary sulcus fixated posterior chamber lens.

PURPOSE: To report capsular block syndrome with external blockage of the capsular opening by a posterior chamber lens fixated in the ciliary sulcus. METHOD: Case report. RESULTS: In an 89-year-old man who had undergone cataract surgery, a posterior chamber lens was accidentally fixated in the ciliary sulcus after continuous curvilinear capsulohhexis and phacoemulsification/aspiration. The next day, capsular block syndrome was noted along the posterior chamber lens optic, which was blocking the capsular opening from the outside. CONCLUSION: In all previously reported eyes with capsular block syndrome, the posterior chamber lens had been placed inside the lens capsule to block the continuous curvilinear capsulorhexis opening from the inside.     

白内障术中后囊浑浊的连续环形撕囊术

目的 探讨白内障超声乳化吸出术中后囊浑浊时进行后囊连续环形撕囊术的临床疗效。方法 对2000年11月-2003年4月1973眼自内障超声乳化吸出及人工晶状体植入术，发现后囊浑浊的87眼(浑浊度达2—3级)。按常规完成晶状体超声乳化吸出术后，在后囊中央区作一直径3～4mm的连续环形撕囊，囊袋内植入PMMA人工晶体。结果 术后裸眼视力0．2-0．4者26眼占29．9％，0．5-0．8者37眼占42．5％，1．0以上者24眼占27．6％，裸眼视力0．5以上者共6l眼占70．11％。术后视轴光学通道清晰，无囊样黄斑水肿或视网膜脱离等手术并发症。结论 联合前后囊连续环形撕囊术治疗后囊浑浊白内障，疗效显著，但技术性强，要求术者具有丰富的手术经验和熟练的操作技巧。     

Two cases of late postoperative capsular block syndrome

Two cases of late postoperative capsular block syndrome that occurred 4 and 8.5 years, respectively, were encountered. One case underwent phacoemulsification after continuous curvilinear capsulorhexis in his left eye. The other case had a can opener type capsulorhexis and underwent extracapsular cataract extraction with trabeculectomy. One-piece posterior chamber lenses were implanted in both cases. Upon slit-lamp examination, the posterior capsules were found distorted posteriorly; the capsular openings were apparently sealed by the lens optic. A whitish material existed between the intraocular lens optic and posterior capsule, with thick aggregation in a lower fifth space in case 1. After Nd:YAG laser anterior capsulotomy in case 1, the thick aggregate spread diffusely on the posterior capsule which was sunken completely for 4 weeks. After Nd:YAG capsulotomy, the distorted posterior capsule disappeared and the best corrected visual acuity was restored to 20/20 in both cases.     

Anterior capsular tears and loop fixation of posterior chamber intraocular lenses

Two hundred fifty consecutive postmortem eyes containing posterior chamber intraocular lenses (PC IOLs) were analyzed according to the presence and number of radial anterior capsular tears. Over 90% of cases had been done with the "can opener" technique. A surprisingly high percentage of cases, 86%, had one to five radial tears. Furthermore, our analysis showed that the most consistent and most permanent in-the-bag fixation was achieved when only one tear or less was present in the anterior capsule. Because this study shows that the incidence of radial tears is very high after nuclear expression with "can opener" capsulectomy, it provides a scientific basis supporting the transition toward the continuous circular capsulorhexis technique that is slowly evolving. The latter technique has been shown to minimize the incidence of anterior capsular radial tears. This may ultimately serve to decrease the incidence of PC IOL decentration, an important goal if the use of bimultifocal IOLs and IOLs with small or aspheric optics is to be successful.     

电子撕囊仪在婴幼儿先天性白内障手术中的应用

目的探讨电子撕囊仪在婴幼儿先天性白内障手术中的应用价值和临床效果。方法回顾性分析在我院确诊并进行手术的先天性白内障患儿52例(92只眼)的临床资料。手术中采用电子撕囊仪环形撕开前囊膜。对于机化混浊的后囊膜使用电子撕囊仪环形撕后囊,再行玻璃体切割。观察手术中及术后晶体囊膜情况。随访时间6~17个月。结果 92只眼(100%)使用电子撕囊仪成功完成前囊膜撕开,未改用其他撕囊方法。83只眼一次性形成光滑的前囊圆形切口。9只眼在撕前囊时出现放射状撕裂,立即反方向进行撕囊,均完成撕囊。撕前囊膜成功率90.2%。13只眼一次性形成光滑的后囊圆形切口,撕后囊膜成功率100%。术后1个月,术眼囊膜边缘呈不同程度的机化、变白。术后6个月,所有术眼囊膜边缘呈瓷白色,囊袋发生不同程度皱缩。结论对于婴幼儿先天性白内障手术中囊膜的处理,电子撕囊仪与手法撕囊相比,具有更加广泛的适用性和有效性。     

Capsulorhexis assisted by slit illuminator for white cataract without a red reflex.

The authors investigated the clinical efficacy of a slit illuminator in a surgical microscope during capsulorhexis for white cataract. After staining the anterior capsule, the slit illuminator was adjusted to a width of 3 mm and a height of 12 mm using the slider to obtain a high-contrast image of the anterior capsule, and an angle of 30 degrees to both the left and right was possible using the arc guide. After the anterior capsular puncture was done, a capsulorhexis forceps was used to grasp the capsular edge and a continuous curvilinear capsulorhexis was successfully performed in all 10 cases. Using a slit illuminator in a surgical microscope seems to be a valuable technique for performing a continuous curvilinear capsulorhexis on a mature or intumescent cataract that has no red reflex and high intralenticular pressure.     

后极性白内障超声乳化吸除及折叠型人工晶状体植入术的临床观察

目的：探讨小切口超声乳化治疗后极性白内障的手术技术以及术中、术后并发症的处理方法。方法：46例患者(61只眼)，年龄38-78岁，平均57岁。在表麻下行颈侧透明角膜隧道切口的超声乳化，并对后囊下混浊斑块行剥离吸除、环形撕后囊或剪除混浊的后囊及折叠型人工晶状体植入术。结果：51只眼后囊膜完整，其中6只眼有后囊膜混浊；在10只后囊膜破裂眼中，4只眼有玻璃体脱出需行前段玻璃体切割术，并有1只眼晶状体皮质软壳沉入玻璃体腔引起葡萄膜炎及继发性青光眼需再次行后段玻璃体切割。58只眼人工晶状体囊袋内固定，3只眼睫状沟固定。结论：对后极性白内障行超声乳化手术时，谨慎处理后囊下混浊斑块，可以减少术中、术后的并发症，明显提高患者的术后视力。眼科学报2003；19：92-94     

Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.