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[摘要]
目的:探讨台盼蓝染色晶状体前囊膜的最低有效浓度,评价白内障手术中应用囊膜染色技术的临床意义。
方法:收集2014-03/2016-12成熟期年龄相关性白内障患者60例60眼,晶状体皮质混浊程度为C4~C5、核混浊程度为N3(以晶状体混浊分类系统Ⅱ为标准),随机分为三组。三组患者术中分别使用0.03%、0.015%和0.0075%三种不同浓度台盼蓝。所有患者均由同一经验丰富手术医生完成手法小切口白内障手术。术中观察前囊膜染色情况以及撕囊难易程度。记录连续环形撕囊术(continuous circular capsulorhexis,CCC)成功、后囊袋破裂以及人工晶状体囊袋内植入情况。观察术后1d,1wk,3mo术眼角膜内皮细胞计数、眼压、前房炎症反应、角膜水肿和眼内结构染色情况。
结果:浓度低至0.015%的台盼蓝仍可对晶状体前囊膜有效染色,顺利完成CCC。0.03%与0.015%两组患者CCC成功率和IOL囊袋内植入率均高于0.0075%组,差异均有统计学意义(P<0.0083)。三组患者后囊破裂发生率和角膜内皮细胞平均损失率两两比较,差异均无统计学意义(P>0.0083)。术后晶状体前囊撕囊口边缘及侧切口的着染均于1wk内消失,未见其他眼内结构蓝染,前房炎症反应轻,未发现超过1wk的角膜水肿和眼压升高。
结论:白内障手术中应用台盼蓝晶状体前囊膜染色技术安全有效,可提高手术成功率,建议使用台盼蓝最低有效浓度为0.015%。
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[Abstract]
AIM: To determine the lowest concentration of trypan blue(TB)used to stain the anterior capsule satisfactorily and to evaluate the clinical significance of trypan-blue-assisted capsulorhexis in cataract surgery.
METHODS:Totally 60 cases(60 eyes)of mature age-related cataract, of which the cortex lentis cloudy degree was C4-C5 and the nucleus of the lens was N3, were randomly divided into three groups. Different concentrations of TB, 0.03%, 0.015%, 0.0075%, were used in staining groups respectively to stain the anterior capsule during cataract surgery. All cases were performed with manual small-incision cataract surgery by the same ophthalmologist. The staining effects, the success rate of continuous circular capsulorrhexis(CCC), the posterior capsule rupture and the state of the intraocular lens(IOL)were studied during the operation. The significant statistics was conducted between the groups. The density of corneal endothelial cells, intraocular pressure(IOP), inflammation in anterior chamber, corneal edema, staining of other intraocular structures were also observed at 1d, 1wk, 3mo postoperatively.
RESULTS: Trypan blue in concentrations as low as 0.015% stained the anterior capsule satisfactorily, allowing safe creation of a CCC. At concentrations of 0.03% and 0.015%, the success rate of CCC and the state of the intraocular lens(IOL)was significantly better than 0.0075% group, the difference was statistically significant(P<0.0083). The difference of posterior capsule rupture rates and the rate of lost corneal endothelial cells in three groups were not statistically significant(P>0.0083). The staining of CCC margin and side port disappeared in 1wk after surgery. Inflammation in anterior chamber of all cases was slight. There was not any evidence of residual stain in the anterior segment during the postoperative period. There was no corneal edema and intraocular pressure higher after 1wk.
CONCLUSION: Trypan blue staining of the anterior capsule is a safe and useful technique in cataract surgery, which can raise the success rate of cataract surgery. The 0.015% trypan blue staining, the lowest effective concentration, is strongly considered.
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