小切口手法摘出白内障核娩出困难原因及处理

目的通过小切口手法摘出白内障人工晶状体植入术，核娩出困难原因的分析及处理，提高再手术的成功率，减少手术并发症。方法对小切口手法摘出白内障人工晶状体植入23例（23眼）核娩出困难的病例总结、分析。结果23例中因眼压较低，致核娩出困难8例（其中由于球后麻醉，软化眼球，过于降低眼压6例，玻璃体液化2例）。外切口偏深及早进入前房，前房积血，虹膜脱出6例。内切口偏前，内口较小4例。水分离水分层不充分及失误2例，截囊口过小1例，瞳孔未能充分扩大2例。娩核时致玻璃体脱出3例，悬韧带断裂2例。均放弃人工晶状体植入。23例术后角膜出现雾状浑浊（＋＋），1周左右恢复。结论小切口手法摘出白内障人工晶状体植入术，顺利娩核是手术的一个关键。囊括了麻醉，切口，截囊／撕囊，水分离水分层等手术技巧，环环相扣。每一环节的失误，均会影响核的娩出，而失去小切口手法摘除白内障人工晶状体植入术的效果。

The difficulties of cataract nucleus extraction and treatment in small incision technique

Objective To improve surgical success ratio and reduce surgical complication,analyze the reason of nucleus extraction difficult in small incision.Methods 23 cases with nucleus extraction difficulties from 2003 to 2005 in the operation of cataract small incision were analyzed.Results There were eight cases due to lower intraocular pressure.Six because of too depth in outer incision,earlier entering in and bleeding of anterior chamber and iris prolapse,four encountered small inside incision and forward of its position,two in trouble of inadequacy and error between water separation and water stratification,one in trouble of too small truncation punch mouth,two in trouble of inadequate pupil expanding,three resulting in the vitreous body's prolapse in the course of nucleus pulls,two in trouble of suspensory ligament rupture.Conclusions Contains many kinds of skills such as anaesthesia,incision,separation and stratification of water.All of these skills were linked together.They affect each other.Any mistake will give effect on the nucleus so as to lose the advantages in the operation of cataract in small incision technique.