激光乳化术中后囊破裂的分析

目的 对白内障行激光乳化术时晶状体后囊膜破裂发生频率、原因及如何避免该并发症进行探讨。方法 回顾1年余本科部分病史、随访完整的单纯老年性白内障受术者,就激光乳化操作而导致的晶状体后囊膜破裂的病例进行收集和整理。手术采用德国Aesculap MediTec(蛇牌)公司第3代激光白内障晶状体乳化仪PhacoLase。结果 后囊膜破裂或悬韧带断裂者共有9例,大多发生在前期。其中4眼玻璃体脱出于前房内,占破裂者的44.4％。经行前部玻切等处理后,8例植入后房型人工晶状体。术后角膜水肿4例,瞳孔欠圆、轻微移位1例。术后随访未发现视网膜脱离,玻璃体出血。术后视力大都提高。结论 激光乳化手术前房稳定,涌动控制佳,同时手术者已有一定的超声乳化技术能力,后囊膜破裂的可能性降低。但在向激光乳化转型过程中,后囊膜破裂仍是术中较常发生的一种并发症,应引起重视。

Posterior capsular rupture during laser phacoemulsification

Aim To investigate the frequency of and causes of posterior capsular rupture in laser phacoemulsification (LP). Methods We made a retrospective study of all the cases of senile cataract who had undergone LP in our department in the past 1 year or so and who had complete medical history and follow-up. Cases of posterior capsular rupture resulting from LP were collected. Phacolase, which is the third-generation LP instrument ( Aesculap MediTec , Germany) was used in these LP surgeries. Results There were 9 cases with posterior capsular rupture or zonular fracture, most of which happened in the early stage. Among them, there were 4 cases (44.4%) with vitreous prolapse to anterior chamber. Eight cases received posterior IOL after anterior vitrectomy. Four cases had corneal edema postoperatively. There was no retinal detachment or vitreous hemorrhage during the follow-up. The final visual acuity was improved to various degrees postoperatively. Conclusion In LP, the anterior chamber is more stable, the control of vitreous leap is more desirable, and the surgeons, with some skill in ultrasonic phacoemulsification may make the incidence of posterior capsular rupture lower. But it must be emphasized that posterior rupture is still a common complication in the transition from ultrasonic phacoemulsifi-cation to LP.