小瞳孔行表麻下3.5mm切口手法碎核白内障手术探讨

目的探讨小瞳孔行表麻下3.5mm切口手法碎核白内障摘除联合人工晶体植入术的手术技巧、注意事项及疗效。方法 58例核硬度为Ⅱ~Ⅳ级,充分散瞳后瞳孔直径在1.0~4.0mm的患者行白内障摘除联合人工晶体植入术。其中最重要的步骤是前囊膜的处理,不同情况下处理方法不同。根据瞳孔粘连闭合程度分为:瞳孔缘粘连而无机化膜者;瞳孔区有薄机化膜者;后粘连主要集中于瞳孔区,且机化膜较厚者等。结果术后56眼(96.6%)视力较术前提高,其中视力≥0.6者19眼,0.3~0.5者30眼,0.1~0.2者7眼。术后瞳孔均呈圆形或椭圆形,直径1.5~3.5mm。术中无后囊膜破裂、悬韧带离断、前房出血;术后早期有少量轻微并发症,用药后均缓解;术后远期无明显并发症。结论对小瞳孔行表麻下3.5mm切口手法碎核白内障摘除联合人工晶体植入术的手术,术前需因人而异精心设计制定个性化的手术方案,术后均可取得良好的手术效果。

3.5 mm incision manual nucleofragmentation under topical anesthesia by microcoria

Objective To investigate the surgery techniques, precautions and treatment of 3.5 mm incision manual nucleofragmentation with foldable intraocular lens implantation under topical anesthesia by microcoria. Methods 3. 5 mm incision manual nucleofragmentation under topical anesthesia was performed on 58 cases with Ⅱ-Ⅳ nuclear cataract and fully dilated pupil diameter between 1.0-4. 0 ram. The most important step was how to process the anterior capsule. Ac- cording to adhesion and occlusion degree of pupils, the patients were divided into three types ： pupil margin adhesions with- out membranes ; pupil by a thin membrane; posterior synechiae coneentrate mainly on the pupil area, even with thicker membranes. Results After operation, 56 eyes＇ （96. 6%） visual acuity were improved , out of which 19 eyes were ≥ 0. 6, 30 eyes were 0. 3-0. 5, and 7 eyes were 0. 1-0. 2. The patients showed round or oval pupil with l. 5-3.5 mm in diame- ter. No intraoperative posterior capsular rupture, suspensory ligament transection or hyphema appeared. There were a small amount of mild complications, and relieved after treatment. There were no obvious long-term complications. Conclusions Through careful individvalized desigh before operation, 3.5 mm incision manual nucleofragmentation with foldable in- traocular lens implantation under topical anesthesia could achieve good results in the patients with microcoria.