小切口硬核白内障劈核技术——双刀平面劈核法

目的 寻找一种合理的小切口硬核白内障劈核方法，应用于临床并观察其效果。方法 自己设计两把劈核刀，用于临床上劈开Ⅲ级以上硬核白内障，并在实践中不断改进劈核刀的设计。结果 对256例256眼Ⅲ级以上硬核白内障进行劈开和观察，一次性劈开率为100％，其中246眼的晶状体核经4.5mm长切口安全娩出，另10眼用双刀将核劈成4片后行超声乳化吸出。术后第1天12％的患者在裂隙灯下可见局限于切口附近的角膜基质水肿，25％的患者见局限性角膜后弹力层皱褶，术后3－7d角膜水肿均消失。术后第1天，第7天视力在0．5以上者分别为189眼（73．8％）和242眼（94．9％）。术后角膜散光度为0．84D＋0．75D。结论 双刀平面劈核法具有设计合理，切口小，损伤轻，不受核硬度限制，操作简便，易于掌握的优点。不仅适合小切口非超声乳化白内障手术，也可用于超声乳化白内障术中，是小切口白内障手术理想的劈核方法。

Hard nucleus chopping technique in small-incision cataract surge-ry: two-knife plane chopping

Objective To search for a practical nuclear chopping technique for small incision cataract surgery. Methods We designed two choppers for dividing nucleus in cataract surgery. We used them in our clinical practice of hard nuclear cataract surgery and thus improved the choppers constantly.Results Two hundred and fifty-six cases (256 eyes) of cataract with their nucleus being grade III or harder were involved in our observation. All nuclei had been divided into two halves at one chopping. In 246 eyes, the nuclear halves were delivered through a 4.5mm incision safely.In the other 10 eyes,nuclei were divided into four pieces and the pieces were emulsified and aspirated by an ultrasonic phacoemulsifier.Complications included corneal edema nearby the incision in 12% of the eyes and folding of the desmecent membrane in 25% of the eyes.Visual acuity was 0.5 or better in 189 eyes(73.8%)and 242 eyes (94.9%) on the first and seventh postoperative day respectively.Conclusion Two-knife plane chopping technique has the advantages of reasonable design,small incision,little injury,no limitation by hard nucleus and easy manipulation. Not only can it be used in small-incision non-phacoemulsification surgery,but also in phacoemulsification.It is a practical and ideal chopping technique in small incision cataract surgery.