小切口白内障手术截囊与撕囊联合应用

目的探讨手法小切口白内障手术截囊、撕囊联合应用的方法及效果。方法老年性白内障8600例（8600只眼），均采用了截囊撕囊联合应用，在晶状体前囊右上象限采用截囊（用1ml注射器的5号针头弯钩），于12点位开始环形撕囊至9点位截囊位置，观察术中核易娩出，术后并发症及术后视力。结果8600眼均在联合截囊撕囊情况下顺利完成手术，8593只眼在囊袋内植入人工晶状体，6眼人工晶状体植入睫状沟内，1眼二期植入；术中后囊破裂5眼，占0．058％；悬韧带断裂改行囊内摘出术1只眼，占0．01％。角膜水肿、内皮浑浊30只眼，占0．3％。后弹力层脱离3只眼，占0．03％。术后虹膜反应3只眼，占0．03％。术后高眼压11只眼，占0．12％。术后矫正视力：0．8～1．0者2900眼，占33．7％；0．4—0．6者4218只眼，占49．0％；0．2—0．3者1050只眼，占12．2％；0．1以下者432只眼，占5．1％。结论手法小切口白内障手术截囊撕囊联合应用，特别是Ⅳ-Ⅴ级核者，水分离时较易分离出囊袋，游离至前房，不会因单纯撕囊而造成核娩困难，而致悬韧带断裂，也不会因单纯截囊而造成囊袋裂开，人工晶状体不能植入囊袋。截囊撕囊联合应用方法简便易行，易操作，不需特殊医疗器械，对眼内组织损伤小，并发症少，术后视力恢复较好。

Clinical observation on combined application of eapsulectomy and capsulorhexis in manual small-in- cision cataract surgery

Objective To investigate methods and effect of combined application of capsulectomy and capsulorhexis in manual small-incision cataract surgery. Methods There were 8,600 eyes of 8,600 ca- ses of senile cataract, who all adopted capsulectomy combined with capsulorhexis in the upper right quadrant of anterior lens capsule. By capsulectomy （ using gauge-5 needle hook on 1 ml syringe） , curvilinear capsulo- rhexis began with 12 -00 and continually tore until 9：00 capsulectomy site. Then we observed easiness of in- traoperative nucleus delivery, postoperative complications, and postoperative visual acuity. Results A to- tal of 8,600 eyes of 8,600 cases successfully underwent capsulectomy and capsulorhexis in the surgery. In those cases, intraocular lenses were implanted into sac in 8,593 case, or into ciliary sulcus in 6 cases, while 1 case was secondary implantation. In addition, there were 5 cases with intraoperative posterior capsule rup- ture, accounting for 0. 058% ; 1 case transformed to intracapsular cataract extraction due to ligamentum sus- pensorium breakage, accounting for 0.01% ; 30 cases were complicated with corneal edema and endothelial opacification, accounting for 0.3% ; 3 cases were complicated with Descemet＇ s membrane detachment, ac- counting for 0.03% ; 3 cases were complicated with postoperative iris response, accounting for 0.03% ; and 11 cases had postoperative ocular hypertension, accounting for 0.12%. After surgery, 2,900 patients＇ cor- rected vision ranged from 0.8 to 1.0, accounting for 33.7% ; 4,128 patients＂ corrected vision was 0.4 to 0.6, accounting for 49.0% ; 1,050 patients corrected vision was 0.2 to 0.3, accounting for 12.2% ; and 432 patients corrected vision was at or below 0.1, accounting for 5.1%. Conclusion Combined applica-tion of capsulectomy and curvilinear capsulorhexis during manual small - incision cataract surgery, especially for patients with nucleus grade Ⅳ-Ⅴ, can easily isolate the nucleus from sac and dissociate the nucleus to anterior chamber, which will not cause nucleus delivery difficulty due to simple capsulorhexis, then resulting in ligamentum suspensorium breakage, and will not cause sac split due to simple capsulectomy, then resul- ring in intraocular lenses difficultly implanted into sac. Therefore, combined application of capsulectomy and curvilinear capsulorhexis is simple, convenient, easy to operate, without special medical devices, with little intraocular tissue damage, fewer complications, and better postoperative visual acuity.