In recent years, cataract surgery has undergone a qualitative change in the invention of phacoemulsification technique and perfect make cataract surgery more perfect. However, due to the high technical requirements, and long learning curve , expensive equipment , once complications can cause serious consequences , the majority of primary hospital difficult to spread. The small incision extracapsular cataract extraction surgery , with faster visual recovery equipment requirements low , easy to grasp the advantages of basic hospital treatment of cataract is safe, economical and effective method. Our hospital with small incision phacoemulsification cataract 220 , and achieved good therapeutic effect, and has accumulated a certain amount of clinical experience, are reported below.
近年来， 老年性白内障切除缝合发生了质的变动， 超声乳化技术的创造和完备， 使老年性白内障切除缝合更趋完美。但因为该技术要求高， 学习曲线长， 设施极其昂贵， 一朝显露出来合并症多能引动严重后果， 在广大基层医院难于普及。
1 Materials and Methods
1.1 General Information on hospital medical 2007-12 countryside , age-related cataract patients 220 cases 220 . Excluding cornea and vitreous , binocular by key sub-second operation . 94 males 94 , females 126 cases 126 . Aged 45 to 99 ( mean 75.6 ) years , I eye A preoperative routine ultrasound examination , intraocular pressure, fundus microscope examination. Lens nucleus grading by LCSS Ⅱ grade , Ⅲ grade above 176 cases , Ⅲ grade the following 44 cases , preoperative visual acuity of light perception to 0.05 , visual acuity < 0.02 caught Richard light perception, light positioning , red green felt normal . Surgical instruments for the extracapsular cataract extraction routine microsurgical instruments .
普通资料 医疗队2007-12到农村，岁数有关性老年性白内障患者 220例 220 眼。摈除了角膜及玻璃体病变， 双眼者皆为分次切除缝合。男 94 例 94 眼， 女 126 例 126 眼。岁数 45～99 （均匀７５．６）岁， 术前常理予眼部 Ａ超查缉， 眼压、眼底镜等查缉。
1.2 Methods routine day before surgery I lomefloxacin eye drops , 0.9% NS250ml + gentamicin 160,000 u mixture 5ml lacrimal , 0.9% NS250ml + gentamicin 160,000 u wash conjunctival sac . America Chardonnay eye drops to dilate half an hour before surgery . Retrobulbar anesthesia prior to disinfection with povidone iodine droplets conjunctival sac disinfection, retrobulbar anesthesia, open eyelid open eyelid , conjunctiva 0.9% NS30ml + gentamicin 80 000 u wash , superior rectus suture fixed . 11:00 ~ 1:00 orientation as in the basement vault of the conjunctival flap about 7mm, cautery hemostasis at the limbus for 1 ~ 2mm chord length 6 ~ 7mm depth of 1 / 2 the thickness of the sclera anti eyebrow or linear -shaped plate layers cut into 1.0mm transparent cornea into the anterior chamber , with the 9:00 position to make a clear corneal incision . Cans capsulotomy or continuous curvilinear capsulorhexis , capsule diameter of about 6mm, do subcapsular and nuclear interlayer water separation, so that nuclear loose, Nucleation injectable viscoelastic using capsulotomy needle lift while rotating nuclei, located in the iris in nuclear above the plane to 5ml syringe with perfusion fluid behind the lens ring into the nucleus , nuclear Douzhu , slow side note sets out the waterside . Note suction flushing needle aspiration residual cortex from the lateral incision , injection of viscoelastic expansion of the capsular bag pouch intraocular lens implantation in the capsular bag , suction residual viscoelastic , miosis , incision without suture or suture 1-2 needles. For Ⅲ and above , nuclear larger incision used scissors to expand the circle lens nucleus , postoperative subconjunctival injection of gentamicin 20 000 U, dexamethasone 5mg. After I antibiotics and corticosteroids eye drops, eye 1wk. Postoperative 1d; 1wk; 2wk routine visual acuity, slit lamp, fundus , intraocular pressure checks.
2 Results
2.1 Intraoperative complications of posterior capsule rupture in 16 cases, including 10 cases of small hole, before the injection of viscoelastic on hiatus , successfully implanted IOL . 6 cases of a larger hole , clear vitreous prolapse after IOL seam line fixed in the ciliary sulcus loop . Iridodialysis 12 cases , suture pupil is still round . Iris prolapse seven cases from the incision with iris restorer recovery continue to complete the operation , postoperative pupil is still round . A cut too deep, stitched mouth after another to do everything to continue , surgical smoothly.
2.2 postoperative complications after 1d, corneal edema, 30 cases, including 16 cases of mild edema , edema in 13 cases of moderate and severe edema of one case of full-thickness , mild edema not special treatment , edema first two days was significantly subsided . Severe edema that one case I Beifushu , 50% high-sugar , and local corticosteroid eye drops after the treatment , the first two days into a lamellar edema , the first three days no significant edema. Hyphema 13 cases , Ⅰ 11 cases , Ⅲ grade 2 cases , the semi- supine rest , 20% mannitol 250ml ivgtt qd after one of the first two days subsided , three of three days subsided ; IOL partial bit 3 cases , I reoperation reset ; no incision leakage. All cases had corneal endothelial decompensation and secondary glaucoma.
2.3 visual acuity after 1 to 2 weeks , visual acuity ≥ 0.2 for 189 cases , accounting for 85.7% . Corrected visual acuity ≥ 0.5 for 182 cases , accounting for 82.85% . Light perception before surgery significantly improved compared to 0.05 .
3 Discussion
With microsurgical techniques perfected , small incision phacoemulsification cataract surgery with its economical, efficient , less invasive, astigmatism , quick recovery and other advantages in the rapidly growing popularity of the majority of grass-roots hospitals . With phacoemulsification , it has a short learning curve , learning during surgical safety, equipment requirements , low cost , especially adapted to the relatively difficult for phacoemulsification hard core [ 1-2 ] , the following are a few learning experience .
3.1 It should be noted preoperatively strict aseptic countryside cataract operations at a local hospital , local health conditions is limited and time is short for preoperative preparation of sterile requirements are higher, one day before surgery lomefloxacin eye drops 15 minutes once, a continuous drop four times the conjunctival sac of the antibiotic concentration makes effective concentration to 1 hour time point after antibiotic eye surgery water to fully flush the conjunctival sac , retrobulbar anesthesia before I povidone-iodine disinfectant ( containing an effective iodine 0.5% + _0.05% w / n) eye . Can do a sterile , hospital medical Fuming five years to the countryside to do cataract no case of endophthalmitis .
3.2 Preoperative fully dilated , can understand the size and front and rear lens nucleus envelope situation in order to determine the location and size of the incision . Incision size judgment is small incision phacoemulsification cataract surgery important step in the mouth incision size should adapt hardness nuclear size , incision option is on top of the superior temporal or nasal , central from the limbus of about 1 ~ 2mm, two end away from the limbus of about 1.5 ~ 2.0mm, outer incision incision should be greater than 1 ~ 2mm, trapezoid , ease the nucleus. In the following nuclear grade Ⅲ , cut the chord length is 5mm, nuclear in grade Ⅲ , chord length 6 ~ 7mm, encounter crystals used scissors to expand nuclear large incision on both sides . Incision is too small, prone to cause a nuclear difficult. Laceration prone to cause many of the nuclear and iris and corneal endothelial damage , causing corneal endothelial edema, iridodialysis incision leakage and posterior capsular rupture . The group of two cases of posterior capsular rupture is insufficient for the judge repeatedly cut out the core cause of posterior capsule rupture . 10 cases iridodialysis nuclear delivery time due to small incisions hard lens nucleus led out with the iris root amputation . Corneal incision should go away from the limbus 1mm, prematurely into the anterior chamber , iris scleral flap barrier for small, easily lead to prolapse of the iris from the incision , which not only damage the iris , but also the equipment out of the incision difficulty increases , increase the difficulty of operation . The group 2 patients iris prolapse is premature because incision into the anterior chamber , resulting in less postoperative round pupil and anterior chamber depigmentation more prolonged surgery .
3.3 small incision phacoemulsification cataract surgery cortex aspiration is a crucial step in the cortex residues will not only increase anterior chamber reaction , the machine of the future will affect the intraocular lens seat , and anterior chamber depth to maintain suction cortex of crucial importance , anterior chamber depth to maintain good, swarmed to the posterior capsule may cause cortical been caught before and after capsulotomy hard suction , and needle aspiration occurs in contact with the posterior capsule opportunities increase, which will lead to increased opportunities for posterior capsular rupture . The group of five cases of posterior capsule rupture because of poor maintenance of anterior chamber depth , suction 1:00 posterior cortex when in contact with the posterior capsule rupture causes . Anterior chamber depth to maintain good, pumping causes difficulty increases cortical aspiration for a long time , increase the possibility of corneal edema , aspiration difficulty easily lead to an increased likelihood of residual cortex . The group of eight cases of anterior chamber depth cortex residues because maintaining good, hard suction clean. Do nine o'clock incision is resolved to maintain the anterior chamber depth of a good way to 9 o'clock position incision just the right size needle out of the suction capacity , the main incision has been made into a valve from the side of the incision into the water from the top of the main valve incision , so that the anterior chamber to form a closed space over , anterior chamber depth can be well maintained to ensure no posterior capsular upwelling , leather easy suction .
In short , a small incision non- phacoemulsification cataract surgery is the hard-core poor areas and grass-roots hospitals and cataract safe, economical and efficient method Fuming , strict aseptic technique is necessary, incision suction cortex is safe and effective method.