目的 总结分析飞秒激光辅助行白内障超声乳化手术的仪器参数设置、术中和术后存在的问题及其解决方法。方法 选取2014年3~12月67例白内障患者,年龄42～72岁,核硬度Ⅱ～Ⅳ级(Emery核硬度分级标准),使用LenSx(美国Alcon公司)飞秒激光白内障治疗设备进行手术。参数设定:前囊截囊直径4.9 mm,劈核直径5.1 mm,中央环形劈核直径2.7 mm,主切口宽2.2 mm、长1.4 mm,侧切口宽1.0 mm、角度30°。结果 67例中,无锚定失败者。角膜切口:49例(73.13%)角膜主、侧切口均能完全切透;刀协助制作主切口11例(16.42%),侧切口9例(13.43%)。前囊环形截开:65例(97.01%)前囊环形切开口居中,43例(64.18%)前囊截囊口囊膜完全游离,3例(4.48%)出现前囊口放射状裂开。劈核:仅4例(5.97%)全白白内障劈核不彻底,余患者劈核效果满意。本组无囊袋阻滞综合征、后囊破裂、晶状体核坠落等现象发生。21例(31.34%)明显结膜下出血,所有患者激光术后均有不同程度的瞳孔缩小,8例(11.94%)激光术后,瞳孔小于前囊截囊口。所有患者均顺利完成白内障超声乳化及人工晶状体植入手术。结论 飞秒激光辅助行白内障手术能精确决定囊袋口的大小、形状、位置,决定人工晶状体的居中性和稳定性,减少超声能量的应用,提高白内障手术的精度和质量,对截囊、劈核效果满意;主、侧切口位置及深度的准确性尚待进一步摸索。
Abstract
Objective To summarize instrument parameter settings of femtosecond laser-assisted phacoemulsification surgery, to analyse intraoperative and postoperative problems and the solutions. Methods As a prospective case series study. 67 eyes undergoing femtosecond laser-assisted phacoemulsification with the LenSx femtosecond laser treatment equipment (Alcon Inc.) between March and December 2014 in this hospital were included in the study. Patients aged 42-72 years. Nuclear hardness Ⅱ-Ⅳ grades (according to Emery nuclear hardness grade standards). Parameter settings: anterior capsulotomy diameter of 4.9 mm, chopping nucleus diameter of 5.1 mm, the central ring chopping nucleus diameter of 2.7 mm, primary incision 2.2 mm wide and 1.4 mm long, auxiliary incision 1.0 mm wide and its cutting angle 30 degrees. Results Of all 67 cases observed, no cases developed suction break. Corneal incision: primary incision and auxiliary incision completely cut in 49 cases (73.13%), manual assist ance of making primary incision in 11 cases (16.42%), manual assist ance of making auxiliary incision in 9 cases (13.43%). Anterior capsulotomy: 65 cases (97.01%) had a centered capsulotomy. The resected capsular disc in the 43 cases (64.18%) was completely free-floating, an anterior capsule tear occurred in 3 cases (4.48%). Chopping nucleus: only 4 white cataract cases (5.97%) had not completly chopping nucleus, other patients all had a satisfactoried chopping nucleus. No cases of capsular blockage syndrome (CBS) or posterior capsule rupture (PCR) and nucleus falling occurred. 21 cases (31.34%) developed significantly conjunctival hemorrhage. All of the patients after laser treatment had different degrees of miosis. Among them, 8 eyes’ pupil diameter (11.94%) was less than the anterior capsulotomy diameter. All patients successfully completed phacoemulsification surgery and intraocular lens implantation. Conclusions Femtosecond laser-assisted phacoemulsification surgery accurately determines capsulotomy size, shape and position, determines the intraocular lens centraction and stability, reduces the ultrasound energy, and also can improve the precision and quality of cataract surgery. The effect of anterior capsulotomy and chopping nucleus is satisfactory, but the accuracy of the position and depth of main, auxiliary incision is yet to be further exploration.
关键词
飞秒激光 /
白内障 /
手术
Key words
femtosecond laser /
cataract /
surgery
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