小切口白内障术中后囊膜破裂一期人工晶体植入术观察(1)
[摘要] 目的 评价小切口白内障手术中后囊膜破裂的原因及处理方法。 方法 回顾性分析74例(86眼)糖尿病性白内障患者行小切口白内障联合人工晶体植入术，其中24例后囊膜破裂，玻璃体溢出，行前部玻璃体切割术联合人工晶体植入术。 结果 本组患者手术中后囊膜破裂发生率为27.9%，全部行一期后房型人工晶体植入术。其中2例囊袋内固定，8例睫状沟固定植入，14例行人工晶体双攀缝线固定法植入。随访时间1～24个月，术后视力明显提高，无严重并发症。 结论 后房型人工晶体睫状沟或缝线固定是小切口白内障术中后囊膜破裂一期植入人工晶体的有效方法。
[关键词] 小切口白内障手术；玻璃体切割术；人工晶体；后囊膜破裂
[中图分类号] R776.1 [文献标识码] A [文章编号] 1674-4721(2012)07(a)-0077-02
Observation of first intraocular lens implantation about the posterior capsule rupture in small incision cataract surgeries
, http://www.100md.com
SHA Sha
Ophthalmology Department, Mawangdui Hospital of Hunan Province, Changsha 410073,China
[Abstract] Objective To investigate the reasons and treatments of the posterior capsule rupture in small incision cataract surgeries. Methods Retrospectively analyzed 86 eyes of 74 diabetic cataract patients with small incision cataract surgery, in which 24 eyes were of posterior capsular rupture, vitreous loss, and with anterior vitrectomy and intraocular lens implantation. Results The probabiliy of posterior capsule rupture in this group was 27.9%, and all eyes were operated by the first posterior chamber intraocular lens implantation, including 2 cases were operated by intracapsular fixation, and 8 cases were operated by ciliary sulcus implantation, and 14 cases were operated by suspensive intraocular lens implantation. Follow-up 1 to 24 months, and after the surgery, visual acuity were improved significantly without serious complications. Conclusion Ciliary sulcus fixation and suture fixation of posterior chamber intraocular lens are valid treatments for first intraocular lens implantation about the posterior capsule rupture in small incision cataract surgeries.
, 百拇医药
[Key words] Small incision cataract surgery; Vitrectomy; Intraocular lens; Posterior capsule rupture
在白内障手术中小切口白内障手术联合人工晶体植入术具有术后散光少、视力早期恢复的优点，最常见的并发症是后囊膜破裂并发玻璃体溢出、角膜水肿，若处理不当，可导致人工晶体无法一期植入，术后切口延迟愈合，角膜混浊，继发性青光眼，大泡性角膜炎，角膜失代偿等一系列严重并发症，从而影响视功能的恢复，甚至失明。笔者2009年1月～2011年1月进行了74例(86眼)糖尿病性白内障小切口下白内障囊外摘除术联合人工晶体植入术，术中24例发生后囊膜破裂，玻璃体溢出，行前部玻璃体切割术联合人工晶体植入术，取得良好的临床效果，现报道如下：
1 资料与方法
1.1 一般资料
, http://www.100md.com
74例(86眼)患者手术中24例后囊膜破裂，玻璃体溢出，其中，男10例，女14例，年龄60～90岁，均为糖尿病性白内障患者，核硬度为3～5级。
1.2 后囊破裂时间
手法碎核8例(33%)，晶体圈套器掏出晶体核10例(42%)，抽吸皮质4例(17%)，植入晶体时损伤后囊膜1例，术中患者突然咳嗽挤眼，晶体圈套器刺破后囊1例。
1.3 手术方法
所有的患者均采取角巩缘隧道切口，外切口6 mm，内切口8 mm，在术中发现后囊破裂且前房加深或玻璃体溢出切口时立即停止眼内操作，防止破口继续扩大及玻璃体溢出，向前房及囊袋内注入黏弹剂，将残留皮质及碎核用晶体圈套器掏出。小的破口，行前部玻璃体切除后，继续植入人工晶体，大的破口，行前部玻璃体切除后，将晶体襻植入睫状沟内，如睫状沟内无法植入，则行双襻缝线固定法将襻固定于3点及9点方位的睫状沟，应避开睫状血管。观察切口密闭状况，适当加缝巩膜切口1针。手术结束后术眼加用球周注射地塞米松5 mg。2眼发生一过性睫状区缝线处出血。, 百拇医药(沙莎)
[关键词] 小切口白内障手术；玻璃体切割术；人工晶体；后囊膜破裂
[中图分类号] R776.1 [文献标识码] A [文章编号] 1674-4721(2012)07(a)-0077-02
Observation of first intraocular lens implantation about the posterior capsule rupture in small incision cataract surgeries
, http://www.100md.com
SHA Sha
Ophthalmology Department, Mawangdui Hospital of Hunan Province, Changsha 410073,China
[Abstract] Objective To investigate the reasons and treatments of the posterior capsule rupture in small incision cataract surgeries. Methods Retrospectively analyzed 86 eyes of 74 diabetic cataract patients with small incision cataract surgery, in which 24 eyes were of posterior capsular rupture, vitreous loss, and with anterior vitrectomy and intraocular lens implantation. Results The probabiliy of posterior capsule rupture in this group was 27.9%, and all eyes were operated by the first posterior chamber intraocular lens implantation, including 2 cases were operated by intracapsular fixation, and 8 cases were operated by ciliary sulcus implantation, and 14 cases were operated by suspensive intraocular lens implantation. Follow-up 1 to 24 months, and after the surgery, visual acuity were improved significantly without serious complications. Conclusion Ciliary sulcus fixation and suture fixation of posterior chamber intraocular lens are valid treatments for first intraocular lens implantation about the posterior capsule rupture in small incision cataract surgeries.
, 百拇医药
[Key words] Small incision cataract surgery; Vitrectomy; Intraocular lens; Posterior capsule rupture
在白内障手术中小切口白内障手术联合人工晶体植入术具有术后散光少、视力早期恢复的优点，最常见的并发症是后囊膜破裂并发玻璃体溢出、角膜水肿，若处理不当，可导致人工晶体无法一期植入，术后切口延迟愈合，角膜混浊，继发性青光眼，大泡性角膜炎，角膜失代偿等一系列严重并发症，从而影响视功能的恢复，甚至失明。笔者2009年1月～2011年1月进行了74例(86眼)糖尿病性白内障小切口下白内障囊外摘除术联合人工晶体植入术，术中24例发生后囊膜破裂，玻璃体溢出，行前部玻璃体切割术联合人工晶体植入术，取得良好的临床效果，现报道如下：
1 资料与方法
1.1 一般资料
, http://www.100md.com
74例(86眼)患者手术中24例后囊膜破裂，玻璃体溢出，其中，男10例，女14例，年龄60～90岁，均为糖尿病性白内障患者，核硬度为3～5级。
1.2 后囊破裂时间
手法碎核8例(33%)，晶体圈套器掏出晶体核10例(42%)，抽吸皮质4例(17%)，植入晶体时损伤后囊膜1例，术中患者突然咳嗽挤眼，晶体圈套器刺破后囊1例。
1.3 手术方法
所有的患者均采取角巩缘隧道切口，外切口6 mm，内切口8 mm，在术中发现后囊破裂且前房加深或玻璃体溢出切口时立即停止眼内操作，防止破口继续扩大及玻璃体溢出，向前房及囊袋内注入黏弹剂，将残留皮质及碎核用晶体圈套器掏出。小的破口，行前部玻璃体切除后，继续植入人工晶体，大的破口，行前部玻璃体切除后，将晶体襻植入睫状沟内，如睫状沟内无法植入，则行双襻缝线固定法将襻固定于3点及9点方位的睫状沟，应避开睫状血管。观察切口密闭状况，适当加缝巩膜切口1针。手术结束后术眼加用球周注射地塞米松5 mg。2眼发生一过性睫状区缝线处出血。, 百拇医药(沙莎)