| 目的 探讨白色白内障超声乳化吸除术中的手术难点和处理对策，旨在减少并发症，提高手术成功率。方法 对109眼白色白内障施行超声乳化手术，术中应用吲哚氰绿(ICG)或胎盘蓝(Trypan blue)前囊染色（吲哚氰绿染色22眼；胎盘蓝染色87眼），做连续环形撕囊（CCC），撕囊口直径约4mm~4.5mm，不做晶状体核水分离，采用乳化针头斜面朝下超声乳化 (Bevel-down) 和拦截-劈裂超声碎核 (Stop-and-chop) 技术将晶状体核乳化吸出，吸除皮质，后囊抛光后植入人工晶体。结果 98眼成功完成CCC，于囊袋内将晶状体核乳化吸出；5眼在CCC过程中有一处放射状撕裂口，将晶状体核脱位于前房，于囊膜上将核乳化吸出；6眼在CCC制作过程中有多处放射状撕裂口，CCC失败，扩大手术切口，改白内障囊外摘除术。Ⅲ级核23眼，平均超声能量：18.64+5.52%，平均超声时间：77.43+ 35.47秒；Ⅳ级核68眼，平均超声能量：25.69+8.43%，平均超声时间：100.90+39.44秒；Ⅴ级核12眼，平均超声能量：27.67+10.26%，平均超声时间：155.00+79.43秒。术中4眼发生后囊膜破裂，人工晶体植入睫状沟。术后第1天，部分角膜内皮水肿11眼，于术后3~5天后消退。术后1周最佳矫正视力：＜0.1者5眼，0.1~0.3者13眼，0.3~0.5 者15眼，≥0.5者77 眼。结论 白色白内障具有前囊膜菲薄、质地脆弱，皮质液化，囊袋内压力高，晶状体核较硬等特点。超声乳化术中如何成功地完成CCC，减少角膜内皮细胞的损伤，避免后囊膜破裂是术中的难点。通过前囊膜染色、合理应用不同性质的粘弹剂、采用粘弹剂软壳 ( soft-shell )技术、乳化针头斜面朝下超声乳化和拦截-劈裂超声碎核技术能成功地完成CCC，有效保护角膜内皮，避免后囊膜破裂等并发症的发生。
Objectives To study the challenges and the surgical maneuvers in phacoemulsification in white cataracts, aimed to reduce the complications and perform a successful operation. Methods Phacoemulsification were performed in 109 eyes with white cataract between October 2000 and January 2004. In the surgical procedure the anterior capsular was stained with indocyanine green (ICG) in 22 eyes and with trypan blue in 87 eyes, then continuous curvilinear capsulorhexis (CCC) was created. The diameter of CCC was about 4mm to4.5mm. Hydrodissection was avoided. The techniques of bevel-down and stop-and-chop were chosen, after the residual cortex removed completely, IOL was implanted. Results CCC was completed successful in 98 eyes and emulsifying the nucleus intro-capsular ;there was one radial tear in the CCC in 5 eyes, in those cases first dislocated the nucleus into the anterior chamber, then phacoemulsification was performed in the anterior chamber; failure CCC with several tears was in 6 eyes and operation was changed to ECCE. Three grade of the nucleus density were in 23 eyes, four grade of the nucleus density were in 68 eyes, five grade of the nucleus density were in 12 eyes. Its average phaco power were 18.64+5.52%, 25.69+8.43%, 27.67+10.26% respectively and its average phaco time were 77.43+35.47 seconds; 100.90+39.44 seconds, 155.00+79.43 seconds respectively. Posterior capsular was rupture in 4 eyes and the IOL was implanted in the sulcus. In the first day post-operation there were 11 eyes with cornea edema and the cornea became clear after 3 to 5 days. The visual acuity was less 0.1 in 5 eyes, between 0.1 to 0.3 in 13 eyes, between 0.3 to 0.5 in 15 eyes, better than 0.5 in 77 eyes respectively. Conclusion White cataracts have characteristics including thinner and brittle anterior capsular, cortex liquidization , high introlens pressure and hard nucleus. In surgical procedure the challenges are how to create CCC successful, reduce the damage to corneal endothelium and avoid the rupture of posterior capsular. Dying anterior capsular is helpful to make a successful CCC. Aimed to reducing complications, using the techniques of bevel-down and stop-and-chop seemed safer in white cataract. Ophalthalmic viscosurgical devices (OVDs) play an important role and different viscoelastic materials should be chosen in different phases of the surgical procedure. |
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