Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia

PURPOSE: To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months). RESULTS: Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation. CONCLUSIONS: Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.     

Topical versus sub-Tenon's anesthesia without sedation in cataract surgery.

PURPOSE: To compare pain control using topical anesthesia with that using sub-Tenon's anesthesia for clear corneal phacoemulsification cataract surgery and foldable intraocular lens (IOL) implantation. SETTING: Departments of Ophthalmology, General Hospital Asklepeion Voulas and General Hospital of Athens, University of Athens, Athens, Greece. METHODS: One hundred consecutive patients scheduled for bilateral cataract surgery 1 to 2 months apart were prospectively randomized to receive topical anesthesia (100 eyes) or sub-Tenon's anesthesia (100 eyes). The randomization was stratified so that one half of first-eye surgeries and one half of second-eye surgeries were assigned to each anesthesia group, with each patient receiving each type of anesthesia once. All patients had clear corneal phacoemulsification with foldable IOL implantation. Patients were asked to rate their pain level on a 10-point scale for 4 periods: during the administration of the anesthetic agent, during surgery, immediately after surgery, and 24 hours postoperatively. The surgeon recorded his subjective assessment of ease of surgery and surgical complications using a standardized template. RESULTS: Eighty-one percent of patients who received topical anesthesia and 8% of patients who received sub-Tenon's anesthesia reported no pain during delivery of the anesthetic agent. The mean pain score was 0.19 +/- 0.39 (SD) in the topical group and 1.35 +/- 0.63 in the sub-Tenon's group. The difference between groups was statistically significant (P <.001). Seventy-two percent of patients in the topical anesthesia group and 86% in the sub-Tenon's anesthesia group reported no pain or slight discomfort during surgery (mean score 1.13 +/- 1.57 and 0.57 +/- 1.28, respectively) (P <.001). Ninety percent of topical anesthesia patients and 100% of sub-Tenon's anesthesia patients reported no pain or slight discomfort 30 minutes postoperatively (mean score 0.80 +/- 0.93 and 0.12 +/- 036, respectively) (P <.001). All patients in the topical anesthesia group and 77% in the sub-Tenon's group reported no pain 24 hours postoperatively (mean pain 0.00 +/- 0.00 and 0.23 +/- 0.40, respectively) (P <.001). Complications including prolonged akinesia of the globe, chemosis, and conjunctival hemorrhage occurred significantly more frequently in the sub-Tenon's than in the topical group (P <.001). CONCLUSIONS: Patients having cataract surgery under topical anesthesia had more intraoperative and postoperative discomfort than patients receiving sub-Tenon's anesthesia. However, patients having topical anesthesia reported less pain during its administration and had fewer complications. Both anesthesia methods provided high levels of pain control without additional sedation.     

透明角膜反眉形切口超声乳化人工晶状体植入术临床观察

目的:探讨透明角膜反眉形小切口白内障超声乳化及人工晶状体植入术的手术方法及疗效.方法:对68例(88眼)白内障患者进行透明角膜反眉形切口的超声乳化白内障摘出术,伞部病例均采用表面麻醉及植入硬性人工晶状体,术后观察手术反应、视力和并发症.结果:术后随访第1wk的裸眼视力在0.5以上者有80眼,占91%,术后1mo的矫正视力在0.5以上者为85眼(96%).术后患者无1例出现超过1.00D的角膜散光者.结论:在表面麻醉下行透明角膜反眉形切口的白内障超声乳化及植入硬性人工晶状体手术具有安全、前房形成好、切口不易渗漏、恢复快、散光度数低等特点.     

Subjective visual experience during phacoemulsification and intraocular lens implantation using retrobulbar anesthesia

PURPOSE: To investigate the subjective visual experience of patients during phacoemulsification and intraocular lens (IOL) implantation using retrobulbar anesthesia. SETTING: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. METHODS: Seventy cataract patients who had routine phacoemulsification and posterior chamber IOL implantation under retrobulbar anesthesia were interviewed on the day of their surgery regarding their visual experience in the operated eye during surgery. Thirty-nine men (55.7%) and 31 women (44.3%) were included in the study. Their mean age was 65.1 years (range 37 to 87 years). Preoperative best corrected visual acuity ranged from 6/12 to counting fingers. Sixty eyes (85.7%) had no ocular pathology other than cataract. Eleven patients (15.7%) reported no light perception during the surgery. The rest reported they could see light (59 patients, 84.3%), 1 or more colors (39 patients, 55.7%), flashes (35 patients, 50.0%), movements (34 patients, 48.6%), instruments (12 patients, 17.1%), and the surgeon's fingers or hands (11 patients, 15.7%). The colors seen included red (23 patients, 32.9%), blue (17 patients, 24.3%), yellow (12 patients, 17.1%), green (7 patients, 10. 0%), and orange (1 patient, 1.4%). Eight patients (11.4%) saw a spectrum of colors similar to a rainbow. Thirty-one patients (44.3%) reported that the brightness of light changed during surgery. Five patients (7.1%) found their visual experience frightening. Patients who reported seeing colors (P =.048, Fisher exact test) and flashes of light (P =.027, Fisher exact test) were more likely to find the experience frightening. There was no statistically significant correlation between those who found the experience frightening and patient sex or age, length of surgery, or history of cataract surgery in the fellow eye. CONCLUSIONS: Many patients having phacoemulsification and IOL implantation under retrobulbar anesthesia experienced a variety of visual sensations that were frightening in a small proportion of cases.     

透明角膜切口白内障超声乳化摘除术临床观察

目的:探讨白内障超声乳化摘除联合注入式折叠人工晶状体植入术的效果。方法:对382例475眼行透明角膜切口白内障超声乳化摘除联合注入式折叠人工晶状体植入术的术后视力、并发症及安全性进行研究。结果:患者382例475眼手术顺利,术后1mo视力<0.3者10眼,均为眼底病变,视力未提高,>0.3者56眼,视力>0.5者409眼。患者满意,未出现严重眼部及全身并发症。结论:超声乳化白内障摘除联合注入式折叠人工晶状体植入术,术后视力恢复快,是治疗白内障安全有效的手术方法。     

Cataract surgery under topical anesthesia in patients with coexisting glaucoma

PURPOSE: To evaluate and compare levels of patient discomfort and complications during phacoemulsification with implantation of a foldable intraocular lens (IOL) under topical lidocaine hydrochloride in patients with and without various forms of chronic open-angle and chronic angle-closure glaucoma. SETTING: Two university eye centers in Germany. METHODS: This prospective nonrandomized comparative study comprised 176 eyes of 176 patients with various forms of chronic open-angle glaucoma and chronic angle-closure glaucoma. Eyes with cataract and without a glaucoma diagnosis or history of intraocular surgery served as a control group (n = 212). All patients received a minimum of 5 doses (2 drops per dose) of topical lidocaine hydrochloride 2% before standard temporal clear corneal phacoemulsification and foldable IOL implantation. No intracameral anesthetic injection was given, and no systemic sedatives were used. The main outcome measures were the number of complications and adverse events. RESULTS: The intraoperative complication rate in all patients (n = 388) was capsule tear, 1.3%; zonule tear, 1.8%; vitreous loss, 1.0%; iris prolapse, 0.8%. No statistically significant differences in intraoperative or early postoperative complications were found between the glaucoma and control groups. The mean pain scores of patients were 0.38 +/- 1.1 (SD) in the glaucoma group and 0.36 +/- 0.8 in the control group (P =.21) Patient preference for cataract surgery under topical anesthesia was similar in both groups. CONCLUSIONS: Surgery-related complications and patient discomfort were similar in patients with and without glaucoma who had phacoemulsification and IOL implantation under topical anesthesia. These results indicate that topical anesthesia is safe for routine phacoemulsification with foldable IOL implantation in patients with glaucoma and does not compromise patient comfort.     

Subjective visual experience during phacoemulsification and intraocular lens implantation under topical anesthesia

OBJECTIVE: The aim of this study was to investigate the subjective visual experience of patients during phacoemulsification and intraocular lens (IOL) implantation under topical anesthesia. DESIGN: Postoperative questionnaire survey. PARTICIPANTS: The study cohort consisted of 52 patients with cataracts. There were 18 male (34.6%) and 34 female (65.4%) patients. Their mean (+/- SD) age was 67.5 (+/-10.8) years. INTERVENTION: The patients underwent routine phacoemulsification and IOL implantation under topical anesthesia. MAIN OUTCOME MEASURES: The patients were interviewed on the same day after their operation regarding their visual experience in the operated eye during surgery. RESULTS: All patients (100%) reported that they could see at least some light during the surgery. Some patients reported they could also see one or more colors (50 patients, 96.2%), movements (32 patients, 61.5%), flashes (24 patients, 46.2%), the surgeon's fingers/hands (13 patients, 25%), instruments (12 patients, 23.1%), and/or the surgeon (4 patients, 7.7%). The colors seen included red (24 patients, 46.2%), yellow (23 patients, 44.2%), blue (12 patients, 23.1%), green (7 patients, 13.5%), and orange (6 patients, 11.5%). Eight patients (15.4%) saw the spectrum of colors similar to that of the rainbow. Twenty-four patients (46.2%) reported that the brightness of light changed during the course of the operation. Eight patients (15.4%) found their visual experience frightening. There was no statistically significant association between those who found the visual experience frightening and the sex or age of the patient, a history of cataract operation in the fellow eye, the type of visual sensation experienced, or the presence of coexisting ocular pathology. CONCLUSION: All patients undergoing phacoemulsification under topical anesthesia experience a variety of visual sensations that may be frightening in a small proportion of patients.     

Inzisionen für die biaxiale und koaxiale mikroinzisionale Kataraktchirurgie

Microincision cataract surgery (MICS) represents a new level in the development of cataract surgery. Phacoemulsification with intraocular lens (IOL) implantation via incisions of ≤2 mm may be performed by the coaxial approach, such as conventional phacoemulsification but with a smaller diameter of the phaco tip (C-MICS), or by the biaxial approach, with separation of the phaco tip and irrigation (B-MICS). Compared with standard small-incision cataract surgery, the advantages of MICS are less corneal astigmatism and fewer corneal surface irregularities, with favorable implications for visual quality and early rehabilitation. In the effort toward smaller incisions, special interest should be given to wound integrity, especially regarding the risk of endophthalmitis. With limited corneal elastic capacity, irreversible expansion of the incision with tissue laceration may occur. Smaller incisions are superior only if they cause less trauma. This requires an optimized relationship between incision size and manipulation during IOL implantation as well as attention to safety issues. MICS offers a platform for new benchmarks in phacoemulsification.     

表面麻醉下小切口白内障超声乳化人工晶状体植入术

目的:探讨表面麻醉下小切口白内障超声乳化人工晶状体植入术的临床效果和优点。方法:70例83眼采用表面麻醉下透明角膜小切口白内障超声乳化术并植入折叠式后房型人工晶状体。结果:术后1mo视力>0.3者77眼。术中1眼出现后囊破裂,但人工晶状体顺利植入;1眼外伤性白内障人工晶状体未能植入;糖尿病患者2眼出现并发症。结论:表面麻醉下小切口白内障超声乳化人工晶状体植入术具有术程短、术后视力恢复快的优点。     

Visual sensation during phacoemulsification and intraocular lens implantation using topical and regional anesthesia

PURPOSE: To evaluate patients' visual sensations at different stages of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation under topical and regional anesthesia. SETTING: Department of Ophthalmology, United Christian Hospital and Tseung Kwan O Hospital, Kowloon, Hong Kong, China. METHODS: Seventy-six consecutive patients having phacoemulsification were randomized to a topical anesthesia group (n = 35) or regional anesthesia group (n = 41). The topical anesthesia group received lidocaine hydrochloride 2% gel (Xylocaine) and the regional anesthesia group, a peribulbar or retrobulbar injection of lignocaine 2%. The patients' visual sensations, including light and color sensations, shape of objects, and visual patterns, were evaluated at different stages of surgery. RESULTS: Two patients (4.9%) in the regional anesthesia group and none in the topical anesthesia group experienced total loss of light sensation throughout surgery (P =.50). There was a significant association between color perception and the type of anesthesia at stages 1 and 2 (P<.05) but not at stages 3, 4, and 5 (P>.05). The perception of objects and visual patterns had no association with the type of anesthesia at any stage (P>.05). Of all patients in the study, 56 (73.7%) reported color changes as surgery proceeded. Both groups saw waves, defined as curves with periodic fluctuations in amplitude, at all stages. The perception of some colors and a rectangular moving object was significantly associated with the type of anesthesia at some or all stages (P<.05). CONCLUSIONS: Patients having phacoemulsification and PC IOL implantation under topical or regional anesthesia had a wide spectrum of visual sensations that were similar at most stages of surgery. Patients in the topical anesthesia group perceived more colors at the early stages and more blue throughout surgery than patients in the regional anesthesia group.     

Clorazepate dipotassium versus midazolam for premedication in clear corneal cataract surgery

PURPOSE: To evaluate and compare the efficacy of oral clorazepate dipotassium (Tranxilium) and intravenous midazolam (Dormicum) as premedication agents in retrobulbar anesthesia and clear corneal phacoemulsification with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, University of Essen, Essen, Germany. METHODS: In a prospective clinical trial, 97 consecutive patients (97 eyes) having phacoemulsification with implantation of a foldable IOL were randomized to 2 groups. The first group received 10 mg oral clorazepate dipotassium and the second group, 1 mg intravenous midazolam. The surgeon's subjective experience of patients' cooperation during retrobulbar anesthesia and after surgery was measured on a 5-point Likert scale. The duration of surgery and rate of complications were documented. One day after surgery, the patients' subjective comfort during cataract surgery was evaluated using a 5-point Likert scale and the best corrected visual acuity was determined. RESULTS: The level of anterograde amnesia tended to be higher in the midazolam group than in the clorazepate dipotassium group (4% versus 0% for anesthesia administration; 14% versus 4% for surgery), but the difference between groups was not significant. There were no significant differences in patient cooperation or complications during surgery. Patient satisfaction scores were not significantly different between the groups (P<.14); however, patients in the midazolam group expected to have significantly less pain during surgery (P<.04). The rate of potential visual acuity recovery was similar between groups. CONCLUSIONS: Anterograde amnesia occurred more frequently and patients expected less pain before surgery with midazolam. Both anesthetic agents provided safe and effective premedication for retrobulbar anesthesia in clear corneal cataract surgery.     

Patient pain during different stages of phacoemulsification using topical anesthesia.

PURPOSE: To assess the pain experienced by patients during the different stages of phacoemulsification cataract surgery performed under topical anesthesia. SETTING: Ophthalmic teaching hospital, Dublin, Ireland. METHODS: This prospective study comprised 100 consecutive patients having phacoemulsification under topical anesthesia. Patients were asked to grade the pain they experienced during the different stages of the procedure using a visual analog pain scale from 0 to 10. The pain experienced during the procedure was compared with that experienced after the instillation of a drop of amethocaine. RESULTS: The overall mean pain score was 1.46. The highest mean pain score, which was during the phacoemulsification stage of the procedure, was not significantly more than the score for the administration of the topical anesthetic agent. The duration of surgery was not related to the level of pain during the procedure. CONCLUSIONS: Topical anesthesia was effective in phacoemulsification cataract surgery. Because the highest mean score was not significantly higher than that for the administration of the anesthetic agent, it is possible to counsel patients before surgery that the pain they experience during the procedure will be no worse than that during administration of the anesthetic drops.     

表面麻醉下白内障超声乳化及人工晶状体植入术患者视觉感受特点分析

目的探讨表面麻醉状态下行白内障超声乳化及人工晶状体植入术的患者术中视觉感受的特点。方法选取2010年6月至12月因老年性白内障行白内障超声乳化及人工晶状体植入术的患者90例(90眼),术前及术后0.5h内由同一名医师进行视觉感受问卷调查。结果 79眼(87.8%)在整个手术过程中至少能感受到光的存在,11眼(12.2%)术中无光感。41眼(45.6%)可以看到手术过程中移动的物体。白光(55.6%)、红光(42.2%)、黄光(35·6%)、蓝光(28.8%)和绿光(10.0%)是手术过程中患者感受到的常见颜色光。25例(27.8%)患者术中感到恐惧,19例(21·1%)患者术中感到疼痛,手术满意率为91.1%(82例)。结论表面麻醉下行白内障超声乳化及人工晶状体植入术时,大多数患者术中可以感受到光的存在。对患者术中视觉感受的了解可以帮助患者降低手术过程中的恐惧感。     

No-anesthesia clear corneal phacoemulsification versus topical and topical plus intracameral anesthesia. Randomized clinical trial.

Purpose: To compare the intraoperative pain scores during clear corneal phacoemulsification under no anesthesia, topical anesthesia, and topical plus intracameral anesthesia.Setting: Dr. Agarwal's Eye Hospital and Eye Research Center, Chennai, India.Methods: Seventy-five patients were randomized to have phacoemulsification under no anesthesia, topical anesthesia, or topical plus intracameral anesthesia. Uncooperative or illiterate patients and those with hard cataract, a shallow anterior chamber, or small pupils were excluded. A protocol was established for supplemental anesthesia in case of breakthrough pain during the surgery. Each patient was asked to grade the overall severity of intraoperative pain immediately after surgery on a 10-point visual analog scale. Also evaluated were the general discomfort during surgery, discomfort from the microscope lights, surgeon stress during surgery, and total surgical time. Comparison among the 3 groups was performed using an analysis of variance.Results: No supplemental anesthesia was required in any group. No significant difference was noted in the mean scores of the subjective sensation of pain with or without topical anesthesia (P =.610). The mean scores of patient discomfort from the microscope lights and surgical time were also statistically insignificant. Patient discomfort and surgeon stress during surgery were significantly greater in the no-anesthesia group than in the topical and topical plus intracameral groups (P =.0235 and P = 0.0206, respectively).Conclusion: No-anesthesia clear corneal phacoemulsification was performed by a highly experienced, skilled surgeon without causing an unacceptable level of pain. However, this technique is not suitable for every cataract surgeon or patient.     

表面麻醉下小切口非超声乳化白内障摘除及人工晶状体植入

目的:探讨表面麻醉下行小切口非超声乳化白内障囊外摘除及人工晶状体植入术的安全性、有效性及适应证。方法:对150例152眼白内障患者在表面麻醉下行隧道小切口非超声乳化白内障囊外摘除及人工晶状体植入术并观察其麻醉效果及术后视力。结果:所有患者在表面麻醉下均能很好地配合手术顺利完成。无1例改用其他麻醉方法。平均手术时间为24min。术后第2d视力≥0.2者147眼(97%);视力≥0.5者103眼(68%);视力≥0.8者20眼(13%)。结论:表面麻醉下小切口非超声乳化白内障摘除及人工晶状体植入是安全经济、实用、效果好、相对来说易掌握,特别适用于经济欠发达地区成熟、过熟、大核、硬核白内障多的情况。     

Toric intraocular lenses for correcting astigmatism in 130 eyes

OBJECTIVE: This study evaluated the results after implantation of toric intraocular lenses (IOLs) to correct preexisting corneal astigmatism in patients undergoing either cataract or clear lens extraction surgery. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One hundred thirty eyes of 99 patients who underwent phacoemulsification and posterior chamber toric IOL implantation from January 1997 through February 1998 were included in the study. INTERVENTION: Implantation of a toric IOL was performed after cataract surgery (122 eyes) or clear lens extraction surgery (eight eyes). Both preoperative corneal cylinder and refractive cylinder powers were more than 1.50 diopters (D) for all the eyes included in this study. To provide a comparison, we also studied 51 eyes of 45 patients meeting the same preoperative criteria for degree of corneal and refractive cylinder who underwent implantation of a spherical (nontoric) IOL combined with limbal relaxing incisions. The data for both study and comparison groups were analyzed retrospectively. The selection for the two groups was arbitrary. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), mean spherical equivalent, residual refractive cylinder, and toric IOL axis. RESULTS: In the toric IOL group, 84% of eyes achieved 20/40 or better UCVA. In the spherical IOL group, 76% achieved 20/40 or better UCVA. The mean postoperative refractive cylinder was -1.03 +/- 0.79 D in the toric IOL group and -1.49 +/- 0.75 D in the spherical IOL group. CONCLUSIONS: Our results indicate that phacoemulsification and posterior chamber toric IOL implantation is a largely predictable new surgical option to correct preexisting corneal astigmatism in cataract or clear lens extraction surgery.     

Pain induced by phacoemulsification performed by residents using topical anesthesia.

BACKGROUND AND OBJECTIVE: To evaluate patient-reported pain induced by phacoemulsification performed by residents using topical anesthesia. PATIENTS AND METHODS: This prospective study comprised 81 eyes of 76 consecutive patients having phacoemulsification under topical anesthesia. Surgery was performed by an experienced surgeon (group 1; n=41 eyes) or by two residents (group 2; n=40 eyes). No sedation or intracameral anesthesia was used in either group. Eighty eyes had clear corneal phacoemulsification with foldable acrylic posterior chamber intraocular lens implantation. Patients were asked postoperatively to grade the pain they experienced during the procedure using a visual analog pain scale from 0 to 10. RESULTS: The median pain score for the overall pain was 1.59 +/- 1.43 (range: 0 to 6) in group 1 and 1.95 +/- 1.64 (range: 0 to 7) in group 2 (P = .291). The mean pain score for the maximum pain perceived was 2.39 +/- 1.86 (range: 0 to 7) in group 1 and 2.53 +/- 1.67 (range: 0 to 7) in group 2 (P = .734). There was no significant correlation between the duration of surgery and the overall pain score (r = 0.102, P = .365). CONCLUSION: Topical anesthesia had sufficient analgesic effects in selected patients undergoing phacoemulsification cataract surgery by resident surgeons. The pain felt during the operation was low and tolerable.     

Bimanual microincisional phacoemulsification: the future of cataract surgery?

PURPOSE OF REVIEW: Bimanual microincisional cataract surgery has recently become a procedure of interest among cataract surgeons, and a number of trials have shown its potential as a minimally invasive cataract surgery. The purpose of this review is to examine the studies that have been published to date and to evaluate the potential of bimanual phacoemulsification as a method of cataract extraction. RECENT FINDINGS: Recent studies have reinforced the safety of bimanual phacoemulsification. In particular, recently published studies have focused on evaluating various phacoemulsification technologies and their safety when used in bimanual phacoemulsification. Newly developed rollable hydrophilic acrylic ThinOptX lenses have been shown to be implantable in 2.2-mm incisions safely with good visual outcomes. SUMMARY: Bimanual phacoemulsification has been a potential technique for a number of years, but only recently have the technology, software, and technique advanced sufficiently to make bimanual phacoemulsification a feasible method of cataract extraction. Although the main disadvantage to bimanual phacoemulsification remains the lack of intraocular lenses that can fit through microincisions, necessitating the enlargement of corneal wounds for intraocular lens implantation, bimanual phacoemulsification has a number of advantages over traditional small-incision phacoemulsification. Theses advantages have been a source of interest for cataract surgeons and surgical companies who are now developing technologies that will permit the performance of truly microincisional cataract surgery.     

DuoVisc黏弹剂对白内障超声乳化术低密度角膜内皮细胞的保护作用

目的:临床观察DuoVisc黏弹剂对白内障超声乳化术中低密度角膜内皮细胞的保护效果。方法:观察12例角膜内皮细胞密度为652.9～930.3个/mm²的白内障超乳手术眼,术前记录角膜内皮细胞密度、中央角膜厚度,行白内障超声乳化吸出及后房型折叠人工晶状体植入术,术中应用DuoVisc黏弹剂,术后观察角膜内皮细胞变化,计算术后7d内角膜内皮细胞密度及中央角膜厚度。结果:术后早期部分角膜轻度水肿,药物治疗后恢复透明,术后7d内角膜内皮细胞密度为735.6±92.6个/mm²,较术前（798.2±113.1个/mm²）无明显减少(P=0.145),中央角膜厚度（0.53±0.02mm）正常,同术前（0.51± 0.014mm）相比差异无统计学意义(P=0.144)。结论:熟练掌握超声乳化术的情况下,应用DuoVisc黏弹剂行角膜内皮细胞密度低者的白内障超声乳化术是可行的。     

小瞳孔下白内障超声乳化吸除及人工晶状体植入20例

目的：探讨小瞳孔下白内障超声乳化吸除及人工晶状体植入术的难度，技巧，效果，并发症及处理。方法：0.5%爱尔凯因表面麻醉，透明角膜切口人工晶状体调位钩拉开粘连或强直之小瞳孔，行环形撕囊，超声乳化吸除白内障及人工；晶状体植入，结果：术后视力均有不同程度提高，0.1-0.5者3只眼；0.6-0.8者6只眼；0.9-1.0者8只眼；1尺指数-0.05者4只眼，并发症；2例术中前房出血，术后前房积血；3例术后反应重，瞳孔区渗出膜，均经治疗痊愈。结论：白内障超声乳化术在小瞳孔状态下行环形撕囊是完全可行的，但须人工晶状体调位钩拉开瞳孔，小瞳孔下白内障超声乳化术的并发症，较严重的是前房出血，因此在小瞳孔状态下行超声乳化术时，牵拉虹膜一定小心，尽量勿伤及虹膜血管。