悬韧带脆弱的白内障超声乳化技术

目的 :探讨晶状体悬韧带脆弱甚至离断条件下的白内障手术方式 ,比较超声乳化技术和囊外摘除技术的安全性和效果。方法 :回顾性分析术中发现悬韧带脆弱甚至离断的白内障患者 97例 (10 2只眼 )的手术效果 ,囊外摘除手术组 (ECCE组 ) 5 1例 (5 3只眼 )、超声乳化手术组 (Phaco组 ) 4 6例 (49只眼 )。结果 :(1)后囊破裂 悬韧带断裂者 :ECCE组为 14只眼(2 6 4 2 % ) ,Phaco组为 5只眼 (10 2 0 % ) ,两组比较有显著性差异 (P <0 0 5 )。 (2 )后囊混浊需要YAG激光治疗者 :ECCE组为9只眼 (16 98% ) ,Phaco组为 2只眼 (4 0 8% ) ,两组比较有显著性差异 (P <0 0 5 )。 (3)术后矫正视力提高≥ 2行者 :ECCE组为 4 4只眼 (83 0 1% ) ,Phaco组为 4 7只眼 (95 92 % ) ,两组比较有显著性差异 (P <0 0 5 )。结论 :对于存在晶状体悬韧带脆弱甚至离断的白内障患者 ,超声乳化手术的安全性和效果优于囊外手术。超声乳化手术中 ,始终保持前房的稳定 ,选择高分子量的粘弹剂 ,采用劈核技术原位乳化晶状体核 ,在乳化核或吸皮质时利用劈核钩支撑囊袋是手术成功的关键。

Phacoemulsification technique for cataracts in eyes with zonular weakness or dialysis

objective:to investigate the safety and outcome of phacoemulsification and ecce technique for cataracts extraction in eyes with zonular weakness or dialysis.methods:97 cataract cases(102 eyes)with zonular weakness or dialysis were analyzed retrospectively.ecce was performed in 53 eyes and phacoemulsification in 49 eyes.results:(1)posterior capsular rupture and zonular dialysis:14 eyes(26.42%)in ecce group and 5 eyes(10.20%)in phaco group( p <0.05).(2)pco need nd:yag laser:9 eyes(16.98%)in ecce group and 2 eyes(4.08%)in phaco group( p <0.05).(3)postoperative visual acuities improved more than 2 lines:83% in ecce group and 95% in phaco group( p <0.05).conclusions:phaco technique with nuclear chopping in situ is safe and has a better outcome than ecce for cataract patients with fragile capsule and weak zonules.keeping a steady anterior chamber,select viscoelastic with excellent cohesive quality and performing nuclear chopping in situ are the keys for a successful surgery during this phaco technique.