作者：李春林，吴 刚，王安之 作者单位：安康市中心医院眼科，陕西 安康
【摘要】 目的 探讨非超声乳化小切口白内障摘出联合人工晶状体植入术治疗老年性白内障的临床效果。方法 对46例51眼老年性白内障患者施行非超声乳化小切口白内障摘出联合后房型人工晶状体植入术，观察术后视力恢复、散光及并发症。结果 术后1周、1个月、3个月裸眼或矫正视力≥0.5者分别占84.4%、92.2%、94.2%；≥1.0者分别占49.0%、54.9%、56.9%。术前、术后1周、1个月和3个月平均散光分别为（0.92±0.79）D、（1.38±0.58）D、（0.98±0.63）D和（0.97±0.59）D，术后1周与术前比较有显著差异（P<0.001），术后1个月和3个月与术前比较无显著差异（P>0.05）。无娩核困难、后囊膜破裂、玻璃体脱出、人工晶状体偏位和虹膜损伤等并发症。结论 非超声乳化小切口白内障摘出联合人工晶状体植入术治疗老年性白内障具有创伤小、角膜散光小、术后视力恢复良好、并发症少等优点。
【关键词】 老年性白内障；非超声乳化小切口白内障摘出术；人工晶状体植入术
Effect of small incision nonphacoemulsification cataract extraction combined with implantation of artificial lens for treatment of patients with senile cataract
LI Chunlin,WU Gang,WANG Anzhi
(Department of Ophthalmology,the Central Hospital of Ankang City,Ankang 725000,China)
Abstract: Objective To observe the clinical effect of small incision nonphacoemulsification cataract extraction combined with implantation of artificial lens for treatment of patients with senile cataract.Methods Fortysix(51 eyes) patients with senile cataract were performed with small incision nonphacoemulsification cataract extraction combined with implantation of artificial lens,the sight,astigmatism and complications were observed.Results At 1 week,1 month and 3 months after operation,the naked eye or corrected vision(≥0.5) was 84.4%,92.2% and 94.2% respectively,and the sight(≥1.0) were 49.0%，54.9% and 56.9% respectively,the average astigmatism was （1.38±0.58）D、（0.98±0.63）D and （0.97±0.59）D respectively,the average astigmatism was （0.92±0.79）D before operation.There was significant difference in average astigmatism at 1 week after operation and preoperative（P<0.001）,but there was no significant difference at 1 month,3 monthes after operation and preoperation（P>0.05）.There was no complications such as difficulties of cataract nucleus extraction，posterior capsular rupture,prolapsus vitrei,artificial lens dyssymmetry,iris damage,and so on.Conclusion Small incision nonphacoemulsification cataract extraction combined with implantation of artificial lens for patients with senile cataract has small wound，lower astigmatism,good sight recovery and few complication.
Key words: senile cataract;small incision nonphacoemulsification cataract extraction;implantation of artificial lens
白内障为我国最主要的致盲眼病，其目前最有效的治疗方法仍然是白内障摘除术［1］。近几年发展起来的非超声乳化小切口白内障摘除及后房型人工晶体植入术，其临床效果理想。安康市中心医院2003年1月至2007年3月对46例51眼老年性白内障患者施行了非超声乳化小切口白内障摘除及后房型人工晶体植入术，现将结果报道如下。
1 资料与方法
1.1 一般资料 老年性白内障患者46例51眼，男27例，女19例；年龄49～70岁，平均(59.6±8.2)岁，均为老年性白内障；术前视力：光感～0.12。根据Emery及Little的分级标准为例将核硬度分为5级［2］，Ⅱ级核11眼，Ⅲ级核28眼，Ⅳ级核12眼。排除糖尿病视网膜病变、眼外伤、角膜病变。
1.2 物品与器械 术前测量角膜曲率，用美国产SONOGETM测量眼轴长度，同时将测得的角膜曲率数据输入该机。通过微机输入程序按SRKⅡ公式计算并自动打印出需植入人工晶体屈光度；手术特殊器械为苏州产劈核器，人工晶体为美国Alcon公司产PMMA单片式后房型人工晶体,光学直径为5.5 mm及6 mm。植入人工晶体屈光度为+6.00～+28.0 D。
1.3 手术方法 术前充分散大瞳孔；球后或球周麻醉，掌压法软化眼球；穹隆部为基底球结膜瓣；反眉弓状角巩膜隧道切口（切口两端距角巩缘3～4 mm,中间距角巩缘1.5～2 mm，切口弦长6.0～6.5 mm［3］；切口深度达1/3 ～1/2巩膜厚度，向前潜行分离至透明角膜缘内1 mm作内切口）；于11点角膜切口穿刺进入前房，注入黏弹剂；连续环形囊，充分的水分离、水分层，娩核出晶体囊袋；扩大隧道内口达6～7 mm，对Ⅱ、Ⅲ级软核白内障，直接娩出晶体核，对Ⅳ级硬核性白内障，用劈核器将核劈为2瓣，分别娩出；注吸残留皮质，囊袋内植入后房性人工晶体，视切口闭合情况不缝合或缝合1～2针。术后1周、1个月、3个月观察视力、角膜散光及手术并发症。
1.4 统计学处理 计数资料用χ2检验；计量资料数据用均数±标准差（±s）表示，采用t检验，P<0.05为差异有显著性。
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