成熟或过熟期白内障的超声乳化摘除术

目的探讨成熟或过熟期白内障超声乳化手术中前囊连续环形撕囊的手术操作和晶体核乳化方式的选择。方法５９例成熟或过熟期白内障，前囊连续环形撕囊或开罐式截囊，采用分割蚀刻法与劈裂法相结合，或采用旋转木马法，在囊袋内或虹膜瞳孔面乳化晶体核。结果前囊连续环形撕囊成功５１例，改为开罐式截囊８例。术中后囊破裂１例，部分悬韧带断裂１例，乳化头损伤虹膜１例。术后轻度角膜水肿６例，虹膜部分后粘连１例。结论成熟或过熟期白内障超声乳化术行前囊连续环形撕囊是手术成功的关键，晶体核乳化前不行水化分离，术中熟练地运用劈裂法可减少手术操作、减轻术后反应。

Phacoemulsification for mature or hypermature cataracts

OBJECTIVE: To discuss how to choose the methods of capsularhexis and phacoemulsification in cases with mature or hypermature cataract. METHODS: On fifty-nine mature or hypermature cataract patients, continuous circular capsularhexis or can-opener capsulotomy was performed. The nucleus was emulsified by the method of divide and conquer or phaco chop or rotatory carousel in the bag or at the plane of iris. RESULTS: Continuous circular capsularhexis was successful in 51 cases, failed or shifted to can-opener in 8 cases. There were posterior capsular rupture in 1 cases, partial dehiscence of the zonule in 1 cases and iris bitten by the phaco tip in 1 cases. Postoperatively, there were mild corneal edema in 6 cases and iris posterior synechia in 1 cases. CONCLUSION: Continuous circular capsularhexis is the key point to obtain a successful phacoemulsification for mature or hypermature cataract. Hydrodissection is not important before the phacoemulsification. Skillful phaco chop can reduce the surgical manipulation and the postoperative reaction.