虹膜拉钩在白内障超声乳化术中的应用

目的 评价小瞳孔白内障手术中用虹膜拉钩及传统方法扩瞳对术眼瞳孔和视功能的影响。方法 43眼用虹膜拉钩扩瞳(拉钩组)，18眼用传统方法扩瞳(对照组)。术前两组视力为眼前手动至0．2，瞳孔直径为1．0～3．5mm，对光反射基本无；两组视力及瞳孔直径的差异无显著性。结果 拉钩组：术中瞳孔缘少量渗血11眼，无后囊膜破裂和瞳孔缘咬伤；术后第1天视力≥0．2为71．4％(30／42眼)，3个月后视力≥0．5为59．5％(25／42眼)；瞳孔边缘不规则5眼，对光反射迟缓41眼、消失2眼，出现眩光2眼，无多视。对照组：术中瞳孔缘少量至中量出血10眼，瞳孔缘咬伤6眼，后囊膜破裂2眼；术后第1天视力≥0．2为55．6％(10／18眼)，3个月后视力≥05为16．7％(3／18眼)；瞳孔边缘不规则11眼，对光反射迟缓11眼、消失7眼，出现眩光5眼、多视2眼。术后3个月，两组视力及瞳孔直径的差异有显著性。结论 在小瞳孔白内障超声乳化术中虹膜拉钩具有扩瞳快且充分、对虹膜损伤小、不易引起炎症出血等优点；对保持并恢复术后瞳孔的形态功能，提高视觉质量具有积极意义。

Phacoemulsification with iris retractor for poorly dilated pupil

Objective To evaluate the surgical outcome in cases of miosis after phacoemulsification with or without using flexible iris retractors.Methods 38 cataract patients (43 eyes) with small pupils underwent phacoemulsification and foldable intraocular lens implantation by using flexible iris retractor intraoperatively for enlarging the pupil , these data were compared with small pupils of 15 cataract patients (18 eyes) without using iris retractor (control).Results In the group of using iris retractor, 25.6% of eyes had mild intraoperative iris bleeding, but no posterior capsule rupture or injury of the iris by phacoemulsification tip during the operation. 71.4% eyes achieved visual acuity better than 0.2(4/20)on the first day, and 59.5% better than 0.5(10/20) 3 months postoperatively. Light reflex of pupils slowed in 95.3%, and disappeared in 4.7% because of excessive stretching of the pupils by using iris retractor, and 4.7% of eyes with glare. In the control group: 55.5% of eyes showed mild to moderate iris bleeding, 11.1% with posterior capsule rupture and 33.3% with injury of the iris by intraoperative phacoemulsification tip. 55.6% got better vieibilit than 0.2(4/20) on the first day, and 16.7% better than 0.5(10/20)3 months postoperatively. Light reflrx of pupils slowed in 61.1%, disappeared in 38.9%, and 27.8% of eyes with glare.Conclusion Using iris retractor in small poor dilated pupils may minimize the trauma of iris, reduce the inflammation, and increase safety of the operation. Proper management paracenteses and gradual enlargement of the pupil to perhaps no more than 5.0 mm are important.