微小撕囊和IOL预植入在白色白内障术中的应用

发布时间：2018-04-19 21:03

本文选题：白色障 + 膨胀性　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:研究微小撕囊对提高膨胀性白色障超声乳化吸除术成功率的临床意义。方法:收集2014年2月至2015年8月,膨胀性白色障18例18眼。与2013年1月2014年1月完成的25例25眼,进行回顾性研究。微小撕囊的手术方法:囊膜染色或不染色,截囊针刺破前囊膜,吸出部分乳液和皮质,做2mm微小环形撕囊,注吸头通过撕囊口将皮质或乳糜液吸出,使囊袋内仅残留晶体核,二次撕囊直径5-5.5mm,常规超乳。结果:微小撕囊组18眼,有2例前囊膜裂开,无后囊膜破裂,连续环形撕囊成功率为88.89%。术后1d,3例后弹力层略有皱襞伴角膜轻度水肿;对照组10例前囊膜破裂,连续环形撕囊成功率为66.67%。2例后囊膜破裂,1例核块坠落,5例角膜水肿,2例眼压轻度升高。连续环形撕囊成功率微小撕囊组高于常规撕囊组,两组比较差异均有统计学意义。结论:微小撕囊法能显著提高膨胀性白色障环形撕囊的成功率,降低手术难度,有效提高超乳成功率。目的:研究过熟性白色白内障超声乳化吸除术的手术技巧并评价其效果。方法:收集2013年2月至2015年8月,过熟性白色白内障24眼。与2013年1月2014年5月,过熟核常规超乳+ECCE手术24例,进行回顾性研究。IOL预植入超乳手术方法:先在核中央乳化出一深直沟槽,再将核一分为二劈裂,重复劈核,将一个1/2核块再分成2块,然后用脉冲能量乳化掉。在囊袋内注入粘弹剂,此时于晶体核下植入人工晶状体于囊袋内,在人工晶体的保护下,将剩下的1/2核块再分成2块,常规超乳去除剩余1/2核,吸除残留皮质,完成手术。结果:实验组24例囊袋完整23例,单侧前囊膜裂开1例,无后囊膜破裂;对照组24例,囊袋完整17例,单侧前囊膜裂开2例,双侧前囊膜裂开1例,后囊膜破裂4例。两种方法对于术中囊袋的安全性比较有显著性差异(p0.05)。两组术后第1,7d角膜透明度比较有显著性差异(p0.05)。术后第1d裸眼视力组间比较有显著差异(P0.05)。术后7d最佳矫正视为组间比较无显著差异(P0.05)。实验组术后1月内皮计数2314±278/mm2,对照组内皮计数2298±256/mm2。2组比较差异无统计学意义(P0.05)。结论:IOL预植入法能安全的完成过熟性白色障的超乳手术,减少超乳手术中后囊膜破裂的风险,提高超乳的成功率,同时使患者获得较好的裸眼视力,无额外的风险,为安全的手术方式。
[Abstract]:Objective: to study the clinical significance of small capsulorhexis in improving the success rate of phacoemulsification of swelling white barrier. Methods: from February 2014 to August 2015, 18 eyes of 18 patients with swelling white barrier were collected. A retrospective study was conducted in 25 cases (25 eyes) completed in January 2014. The operative methods of microcapsulorhexis were as follows: the capsule membrane was stained or not stained, the capsule needle punctured the anterior capsule, part of the emulsion and cortex were sucked out, and the 2mm microannular capsulorhexis was made. The suction head sucked out the cortex or chylous fluid through the capsulorhexis, so that only the residual crystal nucleus could be found in the capsule bag. The secondary capsulorhexis was 5-5.5 mm in diameter. Results: in the group of small capsulorhexis, there were 2 cases with rupture of anterior capsule, no rupture of posterior capsule, and the success rate of continuous circular capsulorhexis was 88.89%. One day after operation, there were 3 cases of posterior elastic layer with slight corneal edema and 10 cases of anterior capsule rupture in the control group. The success rate of continuous circular capsulorhexis was 66.67.2 cases with posterior capsule rupture, 1 case with nuclear mass falling and 5 cases with corneal edema and 2 cases with slight increase of intraocular pressure. The success rate of continuous circular capsulorhexis was higher in the microcapsulorhexis group than in the conventional group, and the difference between the two groups was statistically significant. Conclusion: the microcapsulorhexis method can significantly improve the success rate of circular capsulorhexis of swelling white barrier, reduce the difficulty of operation and improve the success rate of superemulsion. Objective: to study the surgical techniques and evaluate the effect of phacoemulsification for overmature white cataract. Methods: from February 2013 to August 2015, 24 eyes of overmature white cataract were collected. A retrospective study was performed on 24 cases of conventional superemulsion ECCE operation with overmature nucleus in May, 2013. The method of pre-implantation of superemulsion was studied: first emulsifying a deep groove in the center of the nucleus, then splitting the nucleus into two parts and splitting the nucleus repeatedly. Divide a 1 / 2 nuclear block into two pieces and emulsify them with pulse energy. Under the protection of intraocular lens, the remaining 1 / 2 nucleus was subdivided into two pieces, the remaining 1 / 2 nucleus was removed by conventional superemulsion, the residual cortex was sucked, and the residual cortex was removed. Results: in the experimental group, 24 cases had intact capsule, 1 case had unilateral rupture of anterior capsule, and 24 cases in control group, 17 cases had intact capsule, 2 cases had unilateral rupture of anterior capsule, 1 case had bilateral rupture of anterior capsule and 4 cases had rupture of posterior capsule. There was significant difference between the two methods in the safety of intraoperative p0. 05 p0. 05. There was a significant difference in corneal transparency between the two groups on the 1st day after operation (P 0.05). On the first day after operation, there was a significant difference in the uncorrected visual acuity between the two groups (P 0.05). At 7 days after operation, the best correction was regarded as no significant difference between the two groups (P 0.05). The endothelium count was 2314 卤278mm2 in the experimental group and 2298 卤256/mm2.2 in the control group. There was no significant difference in the endothelium count between the experimental group and the control group (P 0.05). Conclusion the overmature white barrier suckling surgery can be safely performed by the preimplantation of 10% IOL, which can reduce the risk of posterior capsule rupture, increase the success rate of suckling, and at the same time, make the patients obtain better naked vision without any additional risk. For safe operation.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.66

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