目的：探讨采用巩膜隧道小切口手法碎核对小瞳孔硬核性白内障摘除折叠式人工晶状体植入术,观察患者术后临床效果。方法：作角膜缘后反眉弓5.5mm巩膜隧道切口,小瞳孔下采用晶状体硬核性手法碎核技术对70例70眼白内障摘除,并植入折叠式或PMMA人工晶状体,观察术后视力、散光程度以及并发症等情况。结果：患者70例70眼中术后1mo视力≥0.5者47眼(67%),0.8以上者17眼(24%),低于0.25者5眼(7%),术前及术后1d,1wk,1mo测得角膜平均散光分别为0.35±0.29,0.42±0.33,0.39±0.32,0.37±0.30D,术后各时间角膜散光之间无统计学意义（P>0.05）。术中后囊膜破裂4眼（6%）,5眼前房出血（7%）,术后角膜内皮水肿6眼（9%）,虹膜后粘连5眼（7%）,眼压增高3眼（4%）,经对症治疗3~5d内消失,后囊膜混浊6眼（9%）,经激光后囊膜打孔治疗恢复。结论：本结果提示小瞳孔反眉弓巩膜隧道小切口手法碎核人工晶状体植入术,克服了长期角膜缘大切口的弊端,最大限度减少了术后散光,提高手术成功率,不需特殊设备,简便易行,其效果可与超声乳化术媲美,可有效地减少术后角膜散光,早期获得良好的视力,降低手术费用。

AIM: To explore the use of scleral tunnel small incision and manual nuclear chopping in small pupil hard nucleus cataract extraction and foldable intraocular lens(IOL) implantation, and observe the postoperative clinical effects in patients.METHODS:Seventy cases 70 eyes underwent small pupil hard nucleus cataract extraction using a 5.5mm scleral tunnel in anti-superciliary arch posterior to corneal limbus, then they were implanted the foldable or PMMA IOL. The postoperative visual acuity, astigmatism degree as well as complications were observed.RESULTS:Of the 70 cases 70 eyes, 47 eyes(67%) with visual acuity≥0.5, 17 eyes(24%)≥0.8, and 5 eyes(7%)<0.25; the average corneal astigmatism of preoperative, 1 day, 1 week, 1 month was 0.35±0.29,0.42±0.33,0.39±032,0.37±0.30D, respectively. There was no significant difference in corneal astigmatism among the postoperative time points(P≥0.05). Intraoperatively, posterior capsular rupture occurred in 4 eyes(6%), hyphema in 5 eyes(7%), corneal edema in 6 eyes(9%), posterior synechia in 5 eyes(7%), increased tension in 5 eyes(7%) which was resolved after treatment, posterior capsule opacification in 6 eyes(9%) which recovered after treatment.CONCLUSION:The results suggest that the small pupil hard nucleus cataract extraction using scleral tunnel small incision and manual nuclear chopping overcome the drawbacks of long-term limbal incision, minimize the postoperative astigmatism, and improve the success rate of surgery, It requires no special equipment, and it is a simple easy method, it has the same effect as phacoemulsification, and it can effectively reduce the corneal astigmatism, get good vision, and reduce the cost of surgery.