摘要
目的 探讨后房玻璃体中央管穿刺在非液化白色膨胀白内障手术中的应用价值.方法 液化白色膨胀白内障263例（285眼）随机分为两组.A组（143眼）在进行连续环形撕囊前首先进行后房玻璃体中央管穿刺抽液0.10～0.15 ml,B组（142眼）仅采取计划性缩小撕囊口直径,酌情联合二次撕囊、囊袋穿刺抽液、压核排液、反向撕囊对接等常规技术.观察术中连续环形撕囊完美程度、虹膜损伤等级、术后次日最佳矫正视力、角膜水肿等级等重要指标.结果 术中未达完美撕囊者A组22眼,B组63眼.其中在前囊处置过程中发生放射状崩裂、无法实施完美撕囊者A组3眼,B组16眼;撕囊口向切线方向撕裂、未能完美完成撕囊者A组19眼,B组47眼.≥1级虹膜损伤A组17眼,B组51眼.手术平均用时A组（9.83±2.14） min,B组（10.25±3.64） min.术后次日最佳矫正视力≥0.3者A组122眼、B组105眼.≥1级角膜水肿A组12眼,B组39眼.其他并发症（包括术中、术后前房积血、术后较明显炎症反应等）A组7眼,B组18眼.经两独立样本t检验、秩和检验、卡方检验,除手术用时外,均为P＜0.01或0.05.另外,本组行后房玻璃体中央管穿刺的143眼中,1次穿刺成功140眼、二次3眼.结论 在非液化白色膨胀白内障手术中,后房玻璃体中央管穿刺通过降低后房玻璃体腔压力可显著缓解晶状体前囊张力、增加前房操作空间、降低撕囊难度、减小手术损伤及手术并发症、提高手术效果.此外,本组后房玻璃体中央管穿刺成功率较既往报道明显提高,推测随着年龄的增长,不仅玻璃体后脱离极为普遍,其波及Petit氏管的玻璃体前脱离也将相当普遍,尤其是上方玻璃体.同时,玻璃体中央管容积也将因玻璃体的液化浓缩而显著扩大.另外,作者认为年龄相关性白内障皮质型至少还应细分为膨化型、固化型和基本型等几个亚型,以更好地指导临床.
Objective To discuss the application of posterior chamber and vitreous Cloquet＇ s canal puncture in cataract surgery.Methods Our 285 eyes of 263 nonliquefied white intumescent cataracts cases without severe diseases were randomly divided into A and B group.Puncture of posterior chamber and 0.10-0.15 ml of liquid was sucked out of the vitreous Cloquet＇ s canal firstly before continuous circular capsulorhexis in group A.Reduced capsulorhexis diameter combined with second are capsulorhexis,capsular puncturing,pressing nucleus to discharge of liquid and reverse capsulorhexis docking was performed according to the actual situation in group B.Continuous circular capsulorhexis successful level,iris damage grade,best corrected visual acuity on postoperative day 1 and corneal edema grade were observed.Results Imperfect capsulorhexis was in 22 eyes in group A and 63 eyes in group B.Radial cracks in anterior capsules was in 3 eyes in group A and 16 eyes in group B.Tangential capsulorhexis tear was in 19 eyes in group A and 47 eyes in group B.Iris damage of more than grade 1 was in 17eyes in group A and 51 eyes in group B.The average operation time was （9.83 ±2.14） minutes in group A and （10.25 ± 3.64） minutes in group B.The best corrected visual acuity better than 0.3 on postoperative day 1 was in 122 eyes in group A and 105 eyes in group B.Corneal edema over grade Ⅰ occurred in 12 eyes in group A and 39 eyes in group B.Other complications including intraoperative and postoperative hyphema and severe inflammatory after operation were in 7 eyes in group A and 18 eyes in group B.Statistical study showed significant difference （P 〈 0.01 or P 〈 0.05）,except for operation time.In addition of 143 eyes in group A,there were 140 eyes punctured successfully in one time and 3 eyes in two times in posterior chamber and vitreous Cloquet＇ s canal puncture.Conclusion Puncture of posterior chamber and vitreous Cloquet＇s canal in cataract surgery can obviously relieve anterior lens capsule tension,increase anterior chamber operation space,reduce capsulorhexis difficulty and decrease operative injury and complications by reducing the pressure from the posterior chamber and vitreous cavity.In addition,according to relative higher successful puncture rate than previous reports,we postulated that not only posterior vitreous detachment but also anterior vitreous detachment which affected the canals of petit were more commonly appeared,especially at the anterior vitreous.Meanwhile,the capacity of Cloquet＇ s canal expanded due to the vitreous hquefaction an concentration.Moreover we suggest that age-related cortical cataract should be classified into expanded type,cured type and basic type at least in order to instruct clinical treatment.
出处
《中华眼外伤职业眼病杂志》
2015年第3期188-194,共7页
Chinese Journal of Ocular Trauma and Occupational Eye Disease
关键词
白内障
分型
临床
分期
临床
环形撕囊
连续
玻璃体
Cataract
Type,clinical
Stage,clinical
Capsulorhexis,circular,continuous
