中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2015年
3期
188-194
,共7页
袁久民%高波%王芳%赵颖%蔚玉辉%赵丽丽%王祯
袁久民%高波%王芳%趙穎%蔚玉輝%趙麗麗%王禎
원구민%고파%왕방%조영%위옥휘%조려려%왕정
白内障%分型,临床%分期,临床%环形撕囊,连续%玻璃体
白內障%分型,臨床%分期,臨床%環形撕囊,連續%玻璃體
백내장%분형,림상%분기,림상%배형시낭,련속%파리체
Cataract%Type,clinical%Stage,clinical%Capsulorhexis,circular,continuous
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.
目的 探討後房玻璃體中央管穿刺在非液化白色膨脹白內障手術中的應用價值.方法 液化白色膨脹白內障263例(285眼)隨機分為兩組.A組(143眼)在進行連續環形撕囊前首先進行後房玻璃體中央管穿刺抽液0.10～0.15 ml,B組(142眼)僅採取計劃性縮小撕囊口直徑,酌情聯閤二次撕囊、囊袋穿刺抽液、壓覈排液、反嚮撕囊對接等常規技術.觀察術中連續環形撕囊完美程度、虹膜損傷等級、術後次日最佳矯正視力、角膜水腫等級等重要指標.結果 術中未達完美撕囊者A組22眼,B組63眼.其中在前囊處置過程中髮生放射狀崩裂、無法實施完美撕囊者A組3眼,B組16眼;撕囊口嚮切線方嚮撕裂、未能完美完成撕囊者A組19眼,B組47眼.≥1級虹膜損傷A組17眼,B組51眼.手術平均用時A組(9.83±2.14) min,B組(10.25±3.64) min.術後次日最佳矯正視力≥0.3者A組122眼、B組105眼.≥1級角膜水腫A組12眼,B組39眼.其他併髮癥(包括術中、術後前房積血、術後較明顯炎癥反應等)A組7眼,B組18眼.經兩獨立樣本t檢驗、秩和檢驗、卡方檢驗,除手術用時外,均為P＜0.01或0.05.另外,本組行後房玻璃體中央管穿刺的143眼中,1次穿刺成功140眼、二次3眼.結論 在非液化白色膨脹白內障手術中,後房玻璃體中央管穿刺通過降低後房玻璃體腔壓力可顯著緩解晶狀體前囊張力、增加前房操作空間、降低撕囊難度、減小手術損傷及手術併髮癥、提高手術效果.此外,本組後房玻璃體中央管穿刺成功率較既往報道明顯提高,推測隨著年齡的增長,不僅玻璃體後脫離極為普遍,其波及Petit氏管的玻璃體前脫離也將相噹普遍,尤其是上方玻璃體.同時,玻璃體中央管容積也將因玻璃體的液化濃縮而顯著擴大.另外,作者認為年齡相關性白內障皮質型至少還應細分為膨化型、固化型和基本型等幾箇亞型,以更好地指導臨床.
목적 탐토후방파리체중앙관천자재비액화백색팽창백내장수술중적응용개치.방법 액화백색팽창백내장263례(285안)수궤분위량조.A조(143안)재진행련속배형시낭전수선진행후방파리체중앙관천자추액0.10～0.15 ml,B조(142안)부채취계화성축소시낭구직경,작정연합이차시낭、낭대천자추액、압핵배액、반향시낭대접등상규기술.관찰술중련속배형시낭완미정도、홍막손상등급、술후차일최가교정시력、각막수종등급등중요지표.결과 술중미체완미시낭자A조22안,B조63안.기중재전낭처치과정중발생방사상붕렬、무법실시완미시낭자A조3안,B조16안;시낭구향절선방향시렬、미능완미완성시낭자A조19안,B조47안.≥1급홍막손상A조17안,B조51안.수술평균용시A조(9.83±2.14) min,B조(10.25±3.64) min.술후차일최가교정시력≥0.3자A조122안、B조105안.≥1급각막수종A조12안,B조39안.기타병발증(포괄술중、술후전방적혈、술후교명현염증반응등)A조7안,B조18안.경량독립양본t검험、질화검험、잡방검험,제수술용시외,균위P＜0.01혹0.05.령외,본조행후방파리체중앙관천자적143안중,1차천자성공140안、이차3안.결론 재비액화백색팽창백내장수술중,후방파리체중앙관천자통과강저후방파리체강압력가현저완해정상체전낭장력、증가전방조작공간、강저시낭난도、감소수술손상급수술병발증、제고수술효과.차외,본조후방파리체중앙관천자성공솔교기왕보도명현제고,추측수착년령적증장,불부파리체후탈리겁위보편,기파급Petit씨관적파리체전탈리야장상당보편,우기시상방파리체.동시,파리체중앙관용적야장인파리체적액화농축이현저확대.령외,작자인위년령상관성백내장피질형지소환응세분위팽화형、고화형화기본형등궤개아형,이경호지지도림상.
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.
