后极性白内障超声乳化手术临床观察

目的探讨后极性白内障超声乳化手术的特点，探讨如何避免和减少手术中后囊膜破裂等并发症。方法回顾性病例研究。分析13例（23眼）后极性白内障超声乳化手术的手术操作、超声乳化仪的参数设置、后囊膜破裂的发生情况、并发症的处理及手术效果。结果23眼中，后囊膜破裂7眼，其中，后极部混浊斑和后囊膜分离时后囊膜破裂4例，前房波动时后囊膜破裂2眼，后囊膜抛光时后囊膜破裂1眼。行前部玻璃体切割3眼，皮质沉入玻璃体腔的1眼行后段玻璃体切割。结论后囊膜破裂可以发生在后极性白内障超声乳化手术的任何阶段，吸除后极部混浊斑时最易发生后囊膜破裂，手术中保持前房稳定和减少对后囊膜的牵拉，最后处理后极部混浊斑，可以避免和减少后囊膜破裂的发生。

Outcomes of surgery for posterior subcapsular cataract

Objective To investigate the effect of phacoemulsification techniques on posterior subcapsular cataracts and to minimize the risk of posterior capsular rupture.Methods The medical records of 23 eyes of 13 patients with posterior subcapsular cataract who had phacoemulsification were reviewed retrospectively.The surgical techniques,parameters of the phacoemulsification machine,intraocular complications,management and surgical outcomes were examined.Results Among the 23 eyes with posterior subcapsular cataract that underwent phacoemulsification surgery,posterior capsule rupture occurred in 7：4 from the removal of posterior subcapsular opacity,2 from anterior chamber collapse,and 1 from polishing the capsule.Anterior vitrectomy was performed on 2 eyes.In 1 eye,the cortex was dislocated posteriorly and was removed later by central vitrectomy.Conclusion Posterior capsule rupture may occur during any stage of posterior subcapsular cataract surgery.Capsule rupture occurs most commonly during posterior opacity removal,and this type of cataract needs more gentle maneuvering to avoid the collapse of the chamber or overinflation.It is important to try to postpone the removal of the opacity until the final stage of cortical aspiration to avoid early rupture of the posterior capsule.