晶状体后囊膜前纤维机化膜摘除术

目的用手法撕除晶状体后囊膜的纤维机化膜,以恢复晶状体后囊膜的透明度,提高白内障手术的视力。方法对4581例(5028只眼)白内障施行囊外摘除或超声乳化手术,其中54例(61只眼)因术中晶状体后囊膜前存在较为致密的纤维机化膜,其中先天性白内障14例(19只眼),老年性白内障27例(27只眼),并发性白内障9例(11只眼),外伤性白内障4例(4只眼),估计手术后将会严重影响视力,故采用手术摘除。具体操作如下:前房内注入粘弹性物质,使晶状体后囊膜略低于平面,先用截囊针由切口插入,钩住纤维膜的边缘,向中央牵拉,使纤维膜的边缘与晶状体后囊膜粘连处游离,再改用撕囊镊,夹持游离的纤维机化膜,完整地从后囊膜撕去。结果采用粘弹性物质屏蔽和截囊针加囊膜镊撕去晶状体后囊膜前纤维机化膜,并保持后囊膜完整40例(42只眼);出现后囊膜裂隙、无缺损10例(13只眼);出现后囊膜裂口追加后囊膜连续环形撕囊4例(6只眼);其中2例(2只眼)施行前段玻切术。所有54例(61只眼)最终将人工晶体置入晶体囊袋内。结论在粘弹性物质屏蔽下,用截囊针将纤维膜游离,再用撕囊镊揭痂法撕除晶状体后囊膜前纤维机化膜是一种安全和有效的手术方法,它可以恢复后囊膜的透明度,提高视力;恢复后囊膜平整,使人工晶体置入后不会倾斜;不会因为术后YAG激光不能击破纤维机化膜,而影响白内障手术后效果。

Extraction of fibrosis membrane under the lens posterior capsule

Objective The fibrosis membrane of lens posterior capsule was tore manually in order to recover the lens posterior capsular transparence and evaluate the post-surgical visual acuity. Methods 4581 cataract patients (5028 eyes) were underwent ECCE or phacoemulsification, therein to thick fibrosis membrane under lens posterior capsule was observed in 54 patient (61eyes) which included 14 pediatric cataract patients (19 eyes), 9 complicated cataract patients (14eyes), 27 senile cataract patients (27eyes), 4 traumatic cataract patients (4 eyes), It was supposed that could affect the post-surgical visual acuity and was extracted surgically. The detail process was described as follow : Viscoelastic materials was injected into anterior chamber, put down the capsular needle through the incision, caught the edge of the fibrosis membrane and pulled it centrally to separate the adhesion between the edge of the fibrosis membrane and the lens posterior capsule, then grasp the fibrosis membrane with capsular forceps, finally removed the fibrosis membrane integrality. Results With the protection of the viscoelastic materials, the fibrosis membrane under the lens posterior capsule was tore with the capsular needle and capsular forceps, During the course, the posterior capsule of 40 cases (42 eyes) was intact; that of 10 patients (13 eyes) had slit, but no hole and 4 patients (6 eyes) had hole and had PCCC, therein to 2 patients (2 eyes) had anterior vitrectomy. The IOL were implanted into the capsular bag in all patients. Conclusions Tearing the fibrosis membrane under the lens posterior capsule with the capsular needle and forceps with the protection of viscoelastic material is safe and effective operation. It can recover transparence of the posterior capsule and improve visual acuity; Keep the posterior capsule to steady the IOL; and also can avoid the fibrosis membrane injured by YAG laser, the injury can usually affect the surgical successful rate.