严若华?潘泽军?吴振球?刘劲芳

[摘要] 目的 观察钻井式楔形劈核超声乳化吸除术治疗硬核白内障的疗效。 方法 2015年12月～2016年12月，我院应用钻井式楔形劈核超声乳化吸除术治疗硬核白内障120例。 结果 术前患者的视力均<0.1，术后1个月最佳矫正视力达（0.62±0.23），其中术后1d，最佳矯正视力≥1.0共25例，术后3d，最佳矫正视力≥1.0达 42例，术后1个月视力明显恢复，最佳矫正视力≥1.0达82例。角膜内皮细胞计数术前（2382.11±270.34）个，术后（2295.26±321.53）个。术后发生后囊膜破损3例、悬韧带离断2例、继发性青光眼1例。 结论 钻井式楔形劈核超声乳化吸除术治疗硬核白内障临床效果确切，能使患者及早地获得最佳的矫正视力，减少了眼内组织的损伤，安全、有效，并发症少，值得临床推广和应用。

[关键词] 硬核白内障；钻井式楔形劈核超声乳化吸除术；最佳矫正视力；角膜内皮细胞计数

[中图分类号] R779.66 [文献标识码] A [文章编号] 2095-0616（2017）09-173-03

Clinical observation of drilling wedge chop phacoemulsification in treatment of hard nuclear cataract

YAN Ruohua PAN Zejun WU Zhenqiu LIU Jinfang

Department of Ophtalmology， Meizhou Aier Eye Hospital， Meizhou 514700， China

[Abstract] Objective To observe the curative effect of drilling wedge chop phacoemulsification in treatment of hard nuclear cataract. Methods 120 patients with hard nuclear cataract who undergoing drilling wedge chop phacoemulsification in our hospital from December 2015 to December 2016 were selected. Results The preoperative visual acuity was<0.1 and best corrected visual acuity of a month after operation was （0.62±0.23）. On 1d after operation， there were 25 cases with best corrected visual acuity ≥1.0. On 3d after operation， there were 42 cases with best corrected visual acuity ≥1.0. On 1 month after operation， there were 82 cases with significant recovery of visual acuity and the best corrected visual acuity ≥1.0. Counts of endothelial cells before operation were （2382.11±270.34） while that after operation were （2295.26±321.53）. After operation， there were 3 cases with posterior capsular damage， 2 cases were with suspensory ligament breaking and 1 case with secondary glaucoma. Conclusion Drilling wedge chop phacoemulsification in treatment of hard nuclear cataract has accurate clinical effect. It can make patients get best corrected visual acuity as soon as possible and reduce injury of best corrected visual acuity. It is safe and effective and it has fewer complications， which is worthy of clinical promotion and application.

[Key words] Hard nuclear cataract； Drilling wedge chop phacoemulsification； Best corrected visual acuity； Counts of endothelial cells

硬核白内障是我国老年人常见的白内障类型之一，最终可导致患者失明致盲。硬核白内障治疗主要采取手术，如超声乳化吸除术和晶状体囊外摘除术等。超声乳化具有切口小、散光小、恢复速度快等优点，但大量研究发现单纯超声乳化手术治疗软核性白内障疗效较好，而硬核白内障由于所需超声能量大、超声乳化时间长，易导致角膜内皮损伤甚至失代偿，恢复慢、且不良反应多。因此，本研究中，我们采用钻井式楔形劈核技术，有助于安全地将坚韧的硬核分割成多个小的碎块乳化吸出。

2015年12月～2016年12月，我院应用钻井式楔形劈核超声乳化吸除术治疗硬核白内障120例，取得了较好的效果，现报道如下。

1 资料与方法

1.1 一般资料

选择2015年12月～2016年12月我院住院治疗的老年性白内障120例，纳入标准：术前均进行眼部检查，包括视力检查并验光、测眼压、核混浊度分级，眼AB超查晶体度数，角膜内皮计数等，视力均<0.1，红绿色觉可辨，排除具有眼科手术史者及精神疾病者。晶体核硬度均为Ⅳ～Ⅴ级。120例患者中，男 68例，女 52例，年龄 60～82岁，平均年龄（67.8±6.5）岁。术前患者的视力均<0.1。……