白内障超声乳化术中晶体核坠入玻璃体的处理

晶体核坠入玻璃体是白内障超声乳化术较为严重的并发症。多由于术者手法不当造成后囊膜破裂所致。本文报导３例白内障超声乳化术中晶体核坠入玻璃体的处理，术后反应及与视力预后相关的因素，分析和讨论白内障超声乳化术中晶体核坠入玻璃体发生的原因及其预防。３例患者均于晶体核坠入玻璃体后７２小时内行经睫状体扁平部的闭合式玻璃体切割术。切除玻璃体，游离晶体核，然后改用后节超声粉碎探头吸引晶体核远离视网膜后乳化吸除。视残留晶体囊膜情况，均经原白内障手术切口于睫状沟内植入后房型人工晶体。术后晶体位置稳定。３例患者术后均有不同程度的炎症反应和角膜水肿，１例术后发生黄斑囊样水肿，１例发生脉络膜脱离，经适当处理后消退。未见其他并发症。术后最终视力０．３～０．６。结果表明，对于坠入玻璃体的晶体核，应及时地改行玻璃体切割术。经过适当的处理，患者最终仍可保留较好的视力。

Management of dropped nuclei after phacoemulsification

Dropped nucleus is one of the serious complications of phacoemulsification.The causes are usually radial tear in continuous circular capsulorhexis and improper surgical manipulations that result in posterior capsule rupture and vitreous loss.We reported the management of 3 cases with retained nuclei after phacoemulsification and discussed the causes and prevention of dropped nucleus during phacoemulsification.The possible postoperative features and visual prognosis after vitrectomy were also demonstrated.All three patients were treated with pars plana vitrectomy to remove the retained nuclei within 72 hours after phacoemulsification.At tha end of the vitrectomy,the cataract typically ends up on the surface of the retina.The nuclei were then brought up to the mid vitreous cavity with a posterior segment phacofragmenter and emulsified.Posterior chamber IOLs were implanted into the sulcus at the end of vitrectomy surgery through the previous cataract surgery incisions and were well centered postoperatively.Postoperative complications included cystoid macular edema in one patient and choroidal detachment in another.Both complications disappeared after medical treatments.No other complications were detected.The final visual acuity ranged from 0 3 to 0 6.The results demonstrated that,once in the vitreous,the nucleus must be removed with vitrectomy as quick as possible.In most patients with dropped nuclei,management with quick and appropriate vitrectomy will allow good visual outcomes.