超声乳化手术治疗高度近视合并白内障的临床研究

目的：观察白内障超声乳化吸除联合人工晶体植入治疗高度近视合并白内障的疗效。方法对46例（65眼），眼轴长度在25.5～32.4mm的高度近视合并白内障患者施行超声乳化摘除，并植入5.5mm折叠式人工晶体。其中眼轴长度25.5～28.5mm39眼（A组），眼轴长度29.0～32.4mm26眼（B组），随访8个月～2年，分别观察术后视力恢复情况及术中术后并发症。结果A组的39眼中，视力恢复≥0.5者33眼（84.6％）；B组的26眼中，视力恢复≥0.5者17眼（65.4％），其中3例患者因白内障较大、较硬，＞Ⅳ级核，改为小切口摘除白内障，并植入人工晶体。2例后囊膜破裂患者均在B组，1例行前玻切后将人工晶体植入睫状沟，术后矫正视力0.5；1例行前玻切，二期行人工晶体睫状沟缝合固定术，术后矫正视力0.3。结论超声乳化摘除白内障联合人工晶体植入术对高度近视合并白内障的治疗安全有效。眼轴短的患者视力恢复总体优于眼轴长的患者；眼轴长的患者出现并发症的几率更大；对于晶状体核较大、较硬者，宜采用小切口摘除联合人工晶体植入的手术方式。

Clinical study of phacoemulsification in treatment of high myopia with cataract

Objective To study the effect of phacoemulsification in treatment of high myopia with cataract .Methods 46 cases （65 eyes） of patients of high myopia with cataract （ ocular axial length 25.5~32.4 mm） underwent phacoemulsification and a 5.5 mm folding artificial crystal was implanted .Two groups were set up：39 eyes （group A） with ocular axial length be-tween 25.5 and 28.5 mm;and 26 eyes （group B） with ocular axial length between 29.0 and 32.4 mm.All the patients were followed up for 8 months to 2 years respectively to observe the postoperative visual acuity as well as intra and post operative complications.Results 33 eyes （84.6%） regained a visual acuity of 0.5 or higher out of 39 eyes in Group A while17 eyes （65.4%） regained a visual acuity of 0.5 or higher out of 26 eyes in Group B.Three of the patients underwent small incision excision to remove cataracts ,followed by implantation of artificial crystal because of their larger and harder cataract （〉gradeⅣ） .2 cases of posterior capsular rupture occurred in group B .One underwent vitrectomy along with intraocular lens implanta-tion in the ciliary groove ,with postoperative corrected visual acuity of 0.5;the other underwent IOL ciliary groove suture fixa-tion, with postoperative corrected visual acuity of 0.3.Conclusion Phacoemulsification for the treatment of high myopia with cataract is safe and effective .Patients with short eye axial are generally superior in visual acuity to patients with long axial ,who have a greater risk of complications .Patients with larger and harder lens nucleus should appropriately employ small incisions excision combined intraocular lens implantation surgery .