两种不同方向巩膜隧道切口对挽核难易度的影响

Influence of two different direction scleral tunnel incisions on nucleus delivery difficulty and complications

摘要:

目的:探讨经巩膜隧道角膜缘后2mm"一字形"与"反眉形"两种不同切口形式对挽核难易度的影响比较及其相关并发症,以及角膜内皮修复的时间、屈光状态临床疗效观察。方法:对82例82眼白内障患者行小切口非超声乳化白内障囊外摘除术联合后房型人工晶状体植入术。分为两组人群,两种切口形式,即经角巩缘后2mm("一字形"切口6mm;"反眉形"切口7mm),准备前端4mm×5mm梨形注水圈套器,在挽核前,水分离后根据核赤道12∶00位是否上翘及切口的松紧,选择先抽吸部分皮质(起到降低囊袋内压力、减少容积、便于观察核的形态、大小、位置,减少套核的盲目性)及晶状体核前后两次使用黏弹剂的方法,将晶状体核顺利套出,从而可以有效地减轻角膜内皮的损伤程度,减少术中术后并发症,提高临床疗效。结果:通过两组人群对比,"一字形"切口挽核操作中优于"反眉形"切口。优点是圈套器易于伸入晶状体核后面托核,时间短,阻力小,囊内压力低,后囊破损几率减少,角膜内皮水肿程度相对减轻。"反眉形"切口,因两侧端切口下移,虽说密闭效果好于"一字形",但伸入圈套器时阻力增大,将核外托时,核顶端于角膜内皮接触紧密,摩擦力相对加大,外拖时间相对延长,故对后囊膜、角膜内皮损伤几率也相对增高,术后观察角膜内皮线状水肿的程度,"反眉形"切口重于"一字形"切口,修复时间延长。结论:小切口非超声乳化白内障囊外摘除术,巩膜遂道两种不同方向切口,在用注水圈套器挽核难易度这个方面比较及临床效果上,"一字形"切口优于"反眉形"切口。

Abstract:

AIM:To compare the difficulty of nucleus delivery about "straight line shape" and "anti-eyebrow shape" scleral tunnel incisions and analyse the correlated complications. And to observe clinical curative effects of endothelial repair time and the refractive state. METHODS:A total of 82 cases (82 eyes) cataract patients were accepted small-incision non-phacoemulsification cataract extraction and posterior chamber type intraocular lens implantation surgery. All patients were divided into two groups,one group was accepted 6mm "straight line shape" scleral incision in 2mm after corneoscleral limbus, the other group was accepted 7mm arc length of "anti-eyebrow shape"incision.Lens nucleus were pulled out through a 4mm×5mm pear-shaped lens loop after the hydrodissection,during the time,aspiring the small part of cortex,using Healon twice in front of and behind the lens nucleus and infusing sodium hyaluronate up and down the lens nucleus according to the 12 o’clock nuclear equator whice was upturned direction and the elasticity of incision. RESULTS:The "straight line shape" groups were superior to the "anti-eyebrow shape" groups, lens loop was easier to extend to the behind of lens nucleus and the time of pulling nucleus was shorter, pressure of lens capsule was lower, the risk of posterior capsule damage was decreased, corneal endothelial edema lessened.For anti-eyebrow incision group, the resistance increased when dragging lens nucleus, corneal edema was more serious than the straight line shape incision. Because the friction was increased and nucleus drag time was relatively longer when the top of the nucleus contacted with the corneal endothelium,therefore, probability of the posterior capsule and corneal endothelial damage was also relatively higher,endothelial repair time prolonged. CONCLUSION:The "straight line shape" scleral incision groups were easier to drag out lens nucleus, the time was shorter, capsule pressure and resistance were lower, which could effectively reduce the risk of posterior capsule damage and corneal endothelial edema.