虹膜拉钩在小瞳孔下白内障手术中的应用

目的 比较小瞳孔白内障手术中用虹膜拉钩扩瞳及放射状瞳孔缘虹膜切开扩瞳的并发症及对视功能的影响.方法 52例（58眼）小瞳孔的白内障行超声乳化吸出联合人工晶状体植入术,其中虹膜拉钩扩瞳（试验组）42眼,放射状瞳孔缘虹膜切开扩瞳（对照组）16眼.比较两组手术时间、超声乳化时间、术中术后并发症及术后视力等指标.结果 试验组：平均手术总时间为（29±6）min,平均超声乳化时间为（58 ±12）s;术中出现虹膜出血（10眼）,虹膜咬伤（2眼）,后囊破裂（1眼）等并发症;术后1d,33眼视力较术前提高,术后3个月38眼视力较术前提高,术后达到最佳终视力平均时间为13 d.术后1d,38眼发生角膜水肿,28眼发生前房反应,28眼发生瞳孔变形.术后1周,瞳孔变形8眼,对光反应迟钝20眼,对光反应消失6眼.对照组：平均手术总时间为（20 ±4） min,平均超声乳化时间为（105 ±18）s;术中出现虹膜出血（16眼）,虹膜咬伤（10眼）,后囊破裂（1眼）等并发症;术后1d,8眼视力较术前提高,术后3个月14眼视力较术前提高,术后达到最佳终视力平均时间为29 d.术后1d,15眼发生角膜水肿,16眼均发生前房反应,16眼均发生瞳孔变形.术后1周,瞳孔变形15眼,对光反应迟钝12眼,对光反应消失4眼.两组在手术时间、超乳时间、术后视力及术后并发症等方面差异均有统计学意义.结论 在小瞳孔白内障超声乳化术中虹膜拉钩具有扩瞳充分、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具有积极意义.

Iris retractor in phacoemulsification under small pupil

Objective To compare the surgical complications and outcome of visual function between using iris retractor and radial corotomy in phacoemulsification under small pupil. Methods 58 eyes of 52 cataract patients with small pupil underwent phacoemulsification and intraocular lens implantation. They were divided into two groups： 42 eyes by using iris retractor for dilating the pupil, and 16 eyes by radial corotomy as control. Results In the group of using iris retractor, the operation time was （29 ± 6） min, and phacoemulsification time was （58 ±12）s. The complications were intraoperative iris bleeding in l0 eyes（23.81% ）, injury of the iris by phacoemulsification tip in 2 eyes （4.67%）, and posterior capsule rupture during the operation in 1 eye（6.25% ）. Visual acuity was better than 0.3 in 33 eyes on the first day, and was improved in 38 eyes compared with that before surgery at 3 months postoperatively. The time of getting best final visual acuity was 13 days. On the first day after surgery, there were 38 eyes with corneal edema, 28 eyes with anterior chamber reaction, and 28 eyes with pupil deformation. And there were 8 eyes with pupil deformation, 20 eyes with sluggish pupil light reflex and no light reflex in 6 eye one week after surgery. In the control group, the operation time was （20±4）min, and phacoemulsification time was （105 ± 18）s. 16 eyes（ 100% ） had intraoperative iris bleeding, 10 eyes（62.50% ） had injury of the iris by phacoemulsification tip, and 1 eye （ 6.25% ） had posterior capsule rupture during the operation. Visual acuity was better than 0 . 3 in 8 eyes on the first day after surgery , and the visual acuity of 1 4 eyes at 3 months after surgery was improved compared with that before surgery. The time of getting best final visual acuity was 29 days. On the first day after surgery, there were 15 eyes with corneal edema, 16 eyes with anterior chamber reaction, 16 eyes with pupil deformation. And there were 15 eyes with pupil deformation, 12 eyes with pu