粘连性小瞳孔手法小切口白内障手术探讨

目的探讨粘连性小瞳孔状态下手法小切口白内障手术方法和技巧。方法对28例30眼粘连性小瞳孔白内障患者,行手法小切口白内障摘除人工晶体植入术,术中借助粘弹剂的特性分离瞳孔缘虹膜后粘连扩大瞳孔,利用水法娩核技术使晶状体核脱入前房。结果术后22眼(73.33%)瞳孔恢复生理圆型,6眼(20.00%)瞳孔直径3～4 mm近圆形边缘欠规则,2眼(6.67%)瞳孔直径5～6 mm近圆形改变。术后所有30只眼一期人工晶体植入率100%,未出现严重并发症。术后28只眼(93.33%)最佳矫正视力明显提高,2只眼(6.67%)视力因眼底黄斑部视网膜陈旧性病变、视神经萎缩而无明显提高。结论借助粘弹剂的特性分离瞳孔缘虹膜后粘连,同时联合水法娩核技术,可以较好地解决粘连性小瞳孔手法小切口非超声乳化手术的两个关键步骤——瞳孔扩大和晶状体核脱入前房。

Analysis of Manual Small Incision Cataract Surgery for Patient with Adhesive Small Pupil

Objective To investigate surgical techniques and skills of manual small incision cataract surgery for patient with adhesive small pupil.Methods 30 cases of 28 patients with adhesive small pupil underwent cataract extraction and intraocular lens implantation throuth small incision,and posterior synechia was separated with viscoelastic to dilate the pupil and nucleus was deliveried into anterior chamber with water irrigation.Results After surgery,22 pupils(73.33%) returned to physiological type,6 pupils(20.00%) achieved 3-4 mm in diameter,and 2 pupils(6.67%) changed into 5-6 mm in diameter.All 30 eyes were sucessfully implantated with intraocular lens in a rate of 100%,and no serious complications happened.After surgery,best corrected visual acuity improved significantly in 28 eyes,and no significant improvement happened in 2 eyes(6.67%) due to old macular lesions and optic atrophy.Conclusion Dilating pupil and delivering nucleus into anterior chamber were two key steps of manual small incision cataract surgery for patient with adhesive small pupil,which can be effectively solved with the viscoelastic and water irrigation technology.