基层医院眼科医师从ECCE向PHACO成功转型初期(临床)体会

目的探讨基层医院眼科医师如何安全成功从ECCE(白内障囊外摘除术thecataractextraction)向PHACO(thecataractphacoemulsification白内障超声乳化吸除手术)转型。方法从ECCE向PHACO转型阶段所作白内障超声乳化手术70例(95眼)。结果 95眼中,80眼顺利完成超声乳化;13眼改成ECCE,2眼用晶体匙挽出晶状体核(其中7例是因为术中出现后囊膜破裂,2眼是因为术中瞳孔过小,6眼是因为核过硬)。术后有不同程度的角膜水肿21眼,3d内减轻或消退19眼,1周内消退2眼。发生后囊膜破裂的7眼中,5眼破口较小,人工晶状体放入睫状沟,2眼缝线固定。术后1周裸眼视力在0.5以上者达60%,0.4上达90%。结论基层医院眼科医师在转型期尚不能全面熟练掌握超声乳化技术时,熟练地掌握ECCE十分重要,只要有勇气并及时转换手术方式,基层医师也可以以较小的代价渡过转型期,完成向超声乳化技术转换。

Experience of Transition of Cataract Procedure from Extracapsular Cataract Extraction to Cataract Phacoemulsification in A Basic-level Hospital

Objective To study the ophthalmologist how to perform PHACO（cataract phacoemulsification）successfully instead of ECCE（extracapsular cataract extraction）in a basic-level hospital. Methods A total of 70 patients of with cataract were analyzed from November 2006 to June 2008. Results In 95 eyes,PHACO was performed successfully in 80 eyes while ECCE were performed in 13 eyes after PHACO failed,and Lens nucleus were pulled with lens spoon in 2 eyes（Rupture of l- eyes posterior capsule in 7 eyes, too small pupils in2 eyes and too hard lens nucleus in 6 eyes）.Different level of cornea edema occurred in 21 eyes which disappeared within 3 days in 19 eyes,and within 7 days in 2 eyes.In 7 eyes with rupture of lens posterior capsule,artificial lens were planted in cilliary groove in 5 eyes because the rupture of lens posterior capsule was small,and artificial lens was fixed with suture in 2 eyes.Postoperative visual acuity in 60% of all eyes reached above or equal to 0.5,while in 90% of all eyes reached above 0.4.Conclusions It is very important for the ophthalmologist in a basic-level hospital to master ECCE before performing PHACO successfully.