目的:探讨小切口非超声乳化囊外摘除术治疗小瞳孔硬核白内障的效果。方法:对小切口非超声乳化囊外摘除术治疗小瞳孔硬核白内障156例173眼的临床资料进行回顾性分析,术后随访12mo,对术后最佳矫正视力、瞳孔情况、人工晶状体情况、术中术后并发症情况进行观察随访分析。结果:术后最佳矫正视力≥0.05者143眼(82.7%),其中101眼(58.4%)≥0.3,术后视力大幅提高,其差异有显著统计学意义(χ2=169.17,P<0.01)。术中有11眼(6.4%)发生后囊破裂,均完成手术并植入人工晶状体。术后有9眼(5.2%)出现一过性眼压增高,经治疗后于术后1wk大多缓解;有29眼(16.8%)发生了角膜水肿,也于术后7d内恢复正常;前房炎性反应及前房积血情况也比较轻微,经治疗后于术后2～12d恢复正常。术后总共发现视网膜病变88眼(50.9%)。小瞳孔原因:糖尿病86例(55.1%),陈旧性葡萄膜炎39例(25.0%),陈旧性葡萄膜炎合并糖尿病者22例(14.1%),闭角型青光眼未手术长期点缩瞳药者5例(3.2%),不明原因瞳孔功能障碍4例(2.6%)。结论:小切口非超声乳化囊外摘除术治疗小瞳孔硬核白内障的疗效确切,安全性高,并发症少,尤其适合基层医院开展。术中关键是处理小瞳孔下的操作,术后影响视力的主要因素是原先存在的玻璃体视网膜病变,小瞳孔的原因主要是糖尿病及陈旧性葡萄膜炎。

·AIM:To investigate the effect of small incision non-phaco extracapsular cataract surgery in the treatment of hard nuclear cataract with small pupil.·METHODS:The clinical data of 156 patients 173 eyes with small-pupil hard nuclear cataract who underwent small incision non-phaco extracapsular cataract surgery were retrospectively analyzed.The patients were followed up for 12 months.Postoperative best-corrected visual acuity(BCVA),pupils,intraocular lens(IOL),intraoperative and postoperative complications were observed and analyzed in the follow-up period.·RESULTS:After 6 months postoperatively,BCVA was achieved ≥0.05 in 143 eyes(82.7%),among which ≥0.3 in 101 eyes(58.4%).Compared with preoperative ones,visual acuity was significantly improved,the difference was significant(χ2=169.17,P<0.01).Although the rupture of posterior capsule occurred in 11 eyes(6.4%)intraoperatively,the operations were all fulfilled and IOL implantations were performed.Postoperatively,transient high intraocular pressure occurred in 9 eyes(5.2%)and mostly recovered with in 1 week after the medication;corneal edema was presented in 29 eyes(16.8%)and healed within 7 days;the inflammation in the anterior chamber and hyphema were mild and recovered to normal in 2 to 12 days.Retinopathies were observed in 88 eyes(50.9%)postoperatively.The causes of small pupil included:diabetes in 86 cases(55.1%);chronic uveitis in 39 cases(25.0%);chronic uveitis combined with diabetes in 22 cases(14.1%);angle-closure glaucoma with long period of medication of miotic eyedrops in 5 cases(3.2%);pupillary defect with unknown causes in 4 cases(2.6%).·CONCLUSION:The effect of small incision non-phaco extracapsular cataract surgery in the treatment of hard nuclear cataract with small pupil is very significant,which should be promoted in primary hospital with high security and few complications.The key to intraoperative procedure is to manage the small pupil.The main cause of the poor postoperative visual acuity is vitreoretinopathy.The causes of small pupil are diabetes and chronic uveitis.·

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