摘要
目的进一步探讨玻璃体切割联合晶状体摘除手术中晶状体囊膜的处理方法，观察不同手术方式下晶状体囊膜的处理特点以及对玻璃体手术结果的影响。方法收集2004年1月1日至2007年3月31日的玻璃体切割联合晶状体摘除病例167例（196只眼），年龄4．75岁，平均35．3岁。其中眼球穿通伤94只眼，孔源性视网膜脱离33只眼，糖尿病性视网膜病变37只眼，其他病例32只眼。根据对晶状体摘除的手术方式不同，患者分为晶状体切除组和超声乳化组。手术原则：保留前囊时要利用负压挠刮吸引法进行前囊膜抛光；保留后囊的眼，环形撕囊的大小要大于（无人工晶状体植入）等于6mm（有人工晶状体植入）。结果玻璃体切割联合晶状体切除62例（70只眼），玻璃体切割联合超声乳化105例（126只眼）。眼内充填长效气体86只眼，硅油53只眼。人工晶状体植入78只眼。术毕保留完整前囊膜35只眼，完整后囊膜67只眼，囊膜不完整94只眼，其中计划性囊膜中央切除32只眼，所有病例晶状体囊膜的手术均达到术前手术计划要求。术后出现角膜变性3只眼，人工晶状体夹持7只眼，硅油溢入前房11只眼，复发性视网膜脱离5只眼。结论玻璃体切割手术中，通过超声乳化或晶状体切除的方法保留晶状体囊膜是可行的。在拟行硅油充填的眼尽量保留完整的前囊膜或者后囊膜，以形成屏障阻挡硅油进入前房，不建议中央区小范围切除；长效气体充填的眼，可酌情行晶状体囊膜中央切除，以减少后发障的发生；在拟行人工晶状体植入的眼，需要保留足够的囊膜以支撑晶状体襻；眼外伤手术中需要考虑术前囊膜的状态、眼内异物的取出方式等，决定囊膜的保留方式。
Objective To further approach how to deal with lens capsule in vitrectomy surgery, and to observe its effect on surgery consequence with different techniques in vitrectomy combined with lens surgery. Methods A case series of 167 （ 196 eyes）consecutive patients who underwent vitrectomy combined with lens extraction were reviewed in our data, including 94 eyes with perforating injury of eyeball and 33 eyes with rhegmatogenous retinal detachment and 37 eyes with diabetic retinopathy, and the other 32 eyes. The case were divided into two groups： lentectomy group preserved anterior lens capsule which was polished by scraping and using suction; phacoemulsification group preserved posterior lens capsule which was polished by irrigation and aspiration. Results There were 62 cases （70 eyes） in lentectomy group and 105 cases （ 126 eyes） in phacoemulsifieation group. In these cases, long acting gas injection was performed in 86 eyes, and silicone oil in 53 eyes,intraocular lens was inserted in 78 eyes. Complete anterior lens capsule was preserved in 35 eyes, and complete posterior lens capsule in 67 eyes. Imcomplete lens capsule was found in 94 eyes, and capsulectomy was carried out in 32 eyes. Conclusion It is feasible that lens capsule was preserved by lentectomy or phacoemulsification in vitrectomy combined with lens surgery. Complete lens capsule should be preserved if silicone oil was planned to tampemade, however, central capsulectomy could be carried out to reduce posterior capsule opaeification for gas tampemade eyes, and sufficient area of lens capsule should be retained if intraocular lens was planned to implantation.
出处
《中国实用眼科杂志》
CSCD
北大核心
2008年第8期800-803,共4页
Chinese Journal of Practical Ophthalmology
关键词
晶状体
囊膜
玻璃体手术
Crystalline lens
Lens capsule
Vitrectomy
