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目的 :探讨晶状体悬韧带脆弱甚至离断条件下的白内障手术方式 ,比较超声乳化技术和囊外摘除技术的安全性和效果。方法 :回顾性分析术中发现悬韧带脆弱甚至离断的白内障患者 97例 (10 2只眼 )的手术效果 ,囊外摘除手术组 (ECCE组 ) 5 1例 (5 3只眼 )、超声乳化手术组 (Phaco组 ) 4 6例 (49只眼 )。结果 :(1)后囊破裂 +悬韧带断裂者 :ECCE组为 14只眼(2 6 4 2 % ) ,Phaco组为 5只眼 (10 2 0 % ) ,两组比较有显著性差异 (P <0 0 5 )。 (2 )后囊混浊需要YAG激光治疗者 :ECCE组为9只眼 (16 98% ) ,Phaco组为 2只眼 (4 0 8% ) ,两组比较有显著性差异 (P <0 0 5 )。 (3)术后矫正视力提高≥ 2行者 :ECCE组为 4 4只眼 (83 0 1% ) ,Phaco组为 4 7只眼 (95 92 % ) ,两组比较有显著性差异 (P <0 0 5 )。结论 :对于存在晶状体悬韧带脆弱甚至离断的白内障患者 ,超声乳化手术的安全性和效果优于囊外手术。超声乳化手术中 ,始终保持前房的稳定 ,选择高分子量的粘弹剂 ,采用劈核技术原位乳化晶状体核 ,在乳化核或吸皮质时利用劈核钩支撑囊袋是手术成功的关键。
OBJECTIVE: To investigate the cataract surgery in the condition that the suspensory ligament of the lens is fragile or even broken, and compare the safety and effectiveness of phacoemulsification and extracapsular extraction. Methods: A retrospective analysis was performed on 97 cases (102 eyes) of cataract patients who were found to have fragile or even discontinuous suspensory ligament. 51 cases (53 eyes) underwent extracapsular cataract extraction (ECCE) group, phacoemulsification The operation group (Phaco group) 46 cases (49 eyes). Results: (1) Posterior capsular rupture + suspensory ligament rupture: 14 eyes (2642%) in ECCE group and 5 eyes (102.0%) in Phaco group were significantly different between the two groups (P <0 0 5). (2) YAG laser treatment was needed for posterior capsule opacity: 9 eyes (16 98%) in ECCE group and 2 eyes (40.8%) in Phaco group showed significant difference (P <0.05 ). (3) The corrected visual acuity of ≥2 in postoperative patients was 44 eyes (83 0 1%) in ECCE group and 47 eyes (95 92%) in Phaco group, there was significant difference between the two groups (P <0 0 5). CONCLUSIONS: The safety and effectiveness of phacoemulsification are superior to those of extracapsular cataract patients with cataract who are fragile or even broken off with the lens suspensory ligament. Phacoemulsification surgery, and always maintain the stability of the anterior chamber, the choice of high molecular weight of the viscoelastic, the use of split core technology in situ emulsification of the lens nucleus, the nucleus pulposus in emulsification or ciliary hook support pouch is the key to successful surgery.