中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
6期
592-596
,共5页
王婷%刘军彩%王姝婷%史伟云
王婷%劉軍綵%王姝婷%史偉雲
왕정%류군채%왕주정%사위운
瞳孔闭锁%并发性白内障%瞳孔直径%葡萄膜炎
瞳孔閉鎖%併髮性白內障%瞳孔直徑%葡萄膜炎
동공폐쇄%병발성백내장%동공직경%포도막염
Pupil atresia%Complicated cataract%Pupil diameter%Uveitis
背景 瞳孔闭锁增加了白内障超声乳化手术的难度,瞳孔扩张不当容易产生诸多并发症,探索合适的瞳孔扩张直径和方法对提高手术疗效十分重要. 目的 评价手法扩张瞳孔术对瞳孔闭锁并发性白内障患者术后瞳孔功能的影响. 方法 收集2006年5月至2012年5月在山东省眼科研究所诊治的陈旧性葡萄膜炎致瞳孔闭锁或膜闭并发性白内障患者30例38眼,对患眼行手法扩张瞳孔术治疗瞳孔闭锁并发性白内障.按照患眼术中瞳孔扩张的大小分为瞳孔扩大≥6.0mm组15眼和瞳孔扩大4.5 ～5.5 mm组23眼,同时行白内障超声乳化摘出联合人工晶状体(IOL)植入术.手术中首先撕除瞳孔区机化膜,然后应用23G眼科显微剪对瞳孔领的机化纤维条带做均匀锯齿状剪开,左右手虹膜拉钩多点扩张瞳孔.手术后局部与全身应用糖皮质激素药物和非甾体类抗炎药物,局部应用扩张瞳孔药物.术后随访3个月,分析不同瞳孔直径对术眼视力、并发症、畏光症状、眼压等情况的影响. 结果 瞳孔扩大≥6.0 mm组手术中扩张瞳孔至(6.9±0.4) mm,瞳孔扩大4.5 ～5.5 mm组扩张瞳孔至(5.1±0.3) mm,两组差异有统计学意义(t=16.100,P=0.000).术后3个月瞳孔扩大≥6.0 mm组瞳孔直径为(4.9±0.4) mm,瞳孔缘有不同程度的撕裂口；瞳孔扩大4.5～5.5 mm组瞳孔直径为(3.5±0.5)mm,瞳孔缘撕裂口少见,2个组瞳孔直径的差异有统计学意义(t=9.820,P=0.000).瞳孔扩大≥6.0mm组瞳孔对光反射迟钝或消失者11眼,明显高于瞳孔扩大4.5 ～5.5 mm组的6眼,差异有统计学意义(x2=8.200,P=0.005).瞳孔扩大≥6.0 mm组主观畏光感为2～3级者12眼,瞳孔扩大4.5～5.Smm组者仅2眼,差异有统计学意义(H=19.840,P=0.000).瞳孔扩大≥6.0 mm组术中虹膜出血者7眼,明显高于瞳孔扩大4.5 ～5.5 mm组的3眼,差异有统计学意义(x2=5.290,P=0.030).术后3个月2个组患眼的视力均有不同程度的提高. 结论 陈旧性葡萄膜炎瞳孔闭锁并发性白内障患眼手术中可采用均匀松解、扩张瞳孔的方法,瞳孔扩张直径不超过5.5 mm时可获得满意的近似生理性瞳孔,提高患者的视觉质量.
揹景 瞳孔閉鎖增加瞭白內障超聲乳化手術的難度,瞳孔擴張不噹容易產生諸多併髮癥,探索閤適的瞳孔擴張直徑和方法對提高手術療效十分重要. 目的 評價手法擴張瞳孔術對瞳孔閉鎖併髮性白內障患者術後瞳孔功能的影響. 方法 收集2006年5月至2012年5月在山東省眼科研究所診治的陳舊性葡萄膜炎緻瞳孔閉鎖或膜閉併髮性白內障患者30例38眼,對患眼行手法擴張瞳孔術治療瞳孔閉鎖併髮性白內障.按照患眼術中瞳孔擴張的大小分為瞳孔擴大≥6.0mm組15眼和瞳孔擴大4.5 ～5.5 mm組23眼,同時行白內障超聲乳化摘齣聯閤人工晶狀體(IOL)植入術.手術中首先撕除瞳孔區機化膜,然後應用23G眼科顯微剪對瞳孔領的機化纖維條帶做均勻鋸齒狀剪開,左右手虹膜拉鉤多點擴張瞳孔.手術後跼部與全身應用糖皮質激素藥物和非甾體類抗炎藥物,跼部應用擴張瞳孔藥物.術後隨訪3箇月,分析不同瞳孔直徑對術眼視力、併髮癥、畏光癥狀、眼壓等情況的影響. 結果 瞳孔擴大≥6.0 mm組手術中擴張瞳孔至(6.9±0.4) mm,瞳孔擴大4.5 ～5.5 mm組擴張瞳孔至(5.1±0.3) mm,兩組差異有統計學意義(t=16.100,P=0.000).術後3箇月瞳孔擴大≥6.0 mm組瞳孔直徑為(4.9±0.4) mm,瞳孔緣有不同程度的撕裂口；瞳孔擴大4.5～5.5 mm組瞳孔直徑為(3.5±0.5)mm,瞳孔緣撕裂口少見,2箇組瞳孔直徑的差異有統計學意義(t=9.820,P=0.000).瞳孔擴大≥6.0mm組瞳孔對光反射遲鈍或消失者11眼,明顯高于瞳孔擴大4.5 ～5.5 mm組的6眼,差異有統計學意義(x2=8.200,P=0.005).瞳孔擴大≥6.0 mm組主觀畏光感為2～3級者12眼,瞳孔擴大4.5～5.Smm組者僅2眼,差異有統計學意義(H=19.840,P=0.000).瞳孔擴大≥6.0 mm組術中虹膜齣血者7眼,明顯高于瞳孔擴大4.5 ～5.5 mm組的3眼,差異有統計學意義(x2=5.290,P=0.030).術後3箇月2箇組患眼的視力均有不同程度的提高. 結論 陳舊性葡萄膜炎瞳孔閉鎖併髮性白內障患眼手術中可採用均勻鬆解、擴張瞳孔的方法,瞳孔擴張直徑不超過5.5 mm時可穫得滿意的近似生理性瞳孔,提高患者的視覺質量.
배경 동공폐쇄증가료백내장초성유화수술적난도,동공확장불당용역산생제다병발증,탐색합괄적동공확장직경화방법대제고수술료효십분중요. 목적 평개수법확장동공술대동공폐쇄병발성백내장환자술후동공공능적영향. 방법 수집2006년5월지2012년5월재산동성안과연구소진치적진구성포도막염치동공폐쇄혹막폐병발성백내장환자30례38안,대환안행수법확장동공술치료동공폐쇄병발성백내장.안조환안술중동공확장적대소분위동공확대≥6.0mm조15안화동공확대4.5 ～5.5 mm조23안,동시행백내장초성유화적출연합인공정상체(IOL)식입술.수술중수선시제동공구궤화막,연후응용23G안과현미전대동공령적궤화섬유조대주균균거치상전개,좌우수홍막랍구다점확장동공.수술후국부여전신응용당피질격소약물화비치체류항염약물,국부응용확장동공약물.술후수방3개월,분석불동동공직경대술안시력、병발증、외광증상、안압등정황적영향. 결과 동공확대≥6.0 mm조수술중확장동공지(6.9±0.4) mm,동공확대4.5 ～5.5 mm조확장동공지(5.1±0.3) mm,량조차이유통계학의의(t=16.100,P=0.000).술후3개월동공확대≥6.0 mm조동공직경위(4.9±0.4) mm,동공연유불동정도적시렬구；동공확대4.5～5.5 mm조동공직경위(3.5±0.5)mm,동공연시렬구소견,2개조동공직경적차이유통계학의의(t=9.820,P=0.000).동공확대≥6.0mm조동공대광반사지둔혹소실자11안,명현고우동공확대4.5 ～5.5 mm조적6안,차이유통계학의의(x2=8.200,P=0.005).동공확대≥6.0 mm조주관외광감위2～3급자12안,동공확대4.5～5.Smm조자부2안,차이유통계학의의(H=19.840,P=0.000).동공확대≥6.0 mm조술중홍막출혈자7안,명현고우동공확대4.5 ～5.5 mm조적3안,차이유통계학의의(x2=5.290,P=0.030).술후3개월2개조환안적시력균유불동정도적제고. 결론 진구성포도막염동공폐쇄병발성백내장환안수술중가채용균균송해、확장동공적방법,동공확장직경불초과5.5 mm시가획득만의적근사생이성동공,제고환자적시각질량.
Background Pupil atresia increases the difficulty of cataract surgery.The improper enlarging pupil will lead to many complications.The appropriate method of pupil dilation is very important to improve the postoperative effect.Objective This study was to evaluate the pupillary function after manually enlarged pupil to different sizes for pupil atresia complicated cataract.Methods A retrospective case-controlled study was designed.Thirty-eight eyes of 30 cases suffered from pupil atresia complicated cataract induced by chronic uveitis were enrolled in Shandong Eye Institute from May 2006 to May 2012.The eyes underwent pupil forming and phacoemulsification and assigned to the pupil enlarged to ≥6.0 mm group (15 eyes) and 4.5-5.5 mm group (23 eyes).The fibrosis membrane at pupil zone was removed,and the fibrosis strip at pupil collar was cut evenly by 23G intraocular microscissors as zigzag shape.Then the pupil was enlarged in multipoint by a pair of left and right iris hook from the main and lateral incisions.The pupils of 15 eyes in the pupil enlarged to ≥6.0 mm group were dilated above 6.0 mm and 23 pupils in the 4.5-5.5 mm group were dilated to 4.5-5.5 mm and followed by routine phacoemulsification and foldable intraocular lens implantation.Topical and systemic corticosteroids and nonsteroidal anti-inflammatory drugs combined topical mydriatic were applied before and after operation.The pupil diameter,light reflex and photophobia symptom in postoperation were compared between the two groups.The visual acuity before and after operation and intra-and post-operative complications were recorded.This study was approved by Ethic Committee of Shandong Eye Hospital,and written informed consent was obtined from each patient before operation.Results The pupil diameter in the pupil enlarged to ≥6.0 mm group was dilated to (6.9±0.4) mm and that of the 4.5-5.5 mm was dilated to (5.1 ±0.3) mm intraoperatively,with a statistical significance between them (t =16.100,P =0.000).Three months later,the pupil diameter in the pupil enlarged to ≥ 6.0 mm group was (4.9 ±0.4)mm,with different degrees of lacerated pupillary margins,and that in the pupil enlarged to 4.5-5.5 mm group was (3.5 ±0.5) mm,with rare lacerated pupillary margins,showing a statistically significant difference (t =9.820,P =0.000).The unresponsive or obtuse light reflex in the pupil enlarged to ≥6.0 mm group was significantly higher than in the pupil enlarged to 4.5-5.5 mm group(11 eyes vs.6 eyes) (x2 =8.200,P =0.005).The subjective photophobia symptom of 2-3 grades in the pupil enlarged to ≥6.0 mm group was in 12 eyes,which was higher than that in the pupil enlarged to 4.5-5.5 mm group (2 eyes) (H=19.840,P=0.000).The iris haemorrhage were seen in 3 eyes in the pupil enlarged to 4.5-5.5 mm group and 7 eyes in the pupil enlarged to ≥6.0 mm group (x2 =5.290,P=0.030).The visual acuities of the operated eyes in the two groups improved at different degrees.Conclusions Approximate physiological pupil and good visual quality can been obtained by manual releasing and enlarging pupil to less than 5.5 mm evenly during the surgery for pupil atresia complicated cataract induced by chronic uveitis.
