表面麻醉颞侧位超声乳化及人工晶状体植入术

目的:探讨并总结表面麻醉颞侧位超声乳化技术及5.5mm无缝线遂道切口人工晶状体植入术的方法和经验。方法:总计植入5.5mmPMMA人工晶状体采用无缝线隧道切口的白内障患者529例(568眼),植入折叠式人工晶状体患者51例(51眼)。前者核硬度为I和II级者248眼,III级296眼,IV级24眼。后者核硬者为I和II级者30眼,III级21眼,颞侧位超声乳化碎核,能量设定为50%~70%,有效超声时间10~88(平均46)s。结果:术后第1d视力≥0.5者分别为75%和76%,术后1mo裸眼或矫正视力≥0.5者分别为87%和84%,平均散光分别为0.25±0.38D和0.58±0.62D,两组比较,差异无显著性(P>0.05)。全部病例均无需缝线,96%的表麻颞侧位超声乳化成功,手术主要并发症是后囊破裂和虹膜色素脱失。结论:表麻颞侧位超声乳化白内障吸除术及5.5mm无缝线隧道切口的人工晶状体植入术与折叠术人工晶状体一样,具有手术时间短,无需缝线,视力恢复快等优点,而价格相对便宜,特别是对不宜在原位手术的患者是一种安全有效的手术方式,故值得推广。

Phacoemulsification and intraocular lens implantation through temporal incision of topical anaesthesia

AIM: To investigate the technique of phacoemusification in situ for cataract extraction and 5.5mm intraocular lens (IOL) implantation through temporal incision of topical anaesthesia. ·METHODS: A total of 529 cases (568 eyes) with 5.5mm non-suture tunnel incision cataract and 51 cases (51 eyes) with 3.2mm incision foldable IOL, were included and the hardness of the former was at grade I and II in 248 eyes, grade Ⅲ in 296 eyes and grade Ⅳ in 24 eyes, and that of the latter was at grade I and II in 30 eyes, grade Ⅲ in 21 eyes. Tunnel incision was made by measure knife of diamond. Cataract extraction was by phacoemulsification using improving in situ nuclear fracture technique. 50%-70% energy was set up and emulsification spent 10 seconds to 1 minute and 28 seconds (mean 46 seconds). 5.5mm PMMA IOL and 6mm foldable IOL were implanted. ·RESULTS: Postoperatively, the visual acuity with spherical correction or without correction were 0.5 or better in 75% and 76% at the first day, and 0.5 or better in 87% and 84% at 1 month. The mean post-operative astigmatism was 0.25±0.38D and 0.58±0.62D one month after operation. There was no statistical difference between two groups (P>0.05). All cases were non-suture. 96% of phacoemulsification was successful in situ. The major complications were posterior capsular rupture and damage of iris. ·CONCLUSION: The technique of phacoemulsification in situ and 5.5mm IOL implantation is as worthy to be spread due to minimum postoperative astigmatism and fast restoration of visual acuity as foldable.