【摘要】 目的 探讨一种简单有效的方法使陈旧性虹膜睫状体炎、抗青光眼术後、眼外伤及因虹膜炎症、纤维素膜覆盖致瞳孔无法散大的白内障患者瞳孔扩大,使白内障超声乳化手术得以顺利进行。方法 收集了32例瞳孔区和瞳孔缘膜性物覆盖,无活动性炎症的膜性小瞳孔患者,采用常规巩膜隧道切口,左上方角膜缘作侧切口,用晶体调位鈎先将虹膜後粘连分开,在用粘弹剂保持前房深度的情况下,用撕囊镊夹住瞳孔缘纤维条带,撕拉纤维膜与瞳孔缘脱离,将瞳孔区、瞳孔缘及虹膜背面的纤维素膜组织尽量清除干净,使虹膜恢复弹性。结果 32例患者撕膜均成功,使瞳孔由术前2～3mm术中扩大为5～6mm。术中并发症:虹膜根部轻度离断2例,占6.25％;虹膜少量出血10例,占31.25％;瞳孔缘虹膜 部分撕裂2例,占6.25％。术後角膜轻度水肿4例,占12.5％;早期前房渗出、瞳孔区渗出者8例,积极抗炎治疗、热敷,均吸收,未留下人工晶体前膜;後囊轻度增生3例。3个月後复查部分虹膜後粘连9例,其中粘连范围<1/3,瞳孔缘7例,>1/3范围2例;晶体位置均正常。观察时间最长2年8个月,最短3个月。观察随访病人31例。讨论 各种原因引起的虹膜炎症反应,纤维素渗出,虹膜後粘连,瞳孔区膜覆盖常导致并发性白内障,需手术治疗。因瞳孔小,使手术的难度加大。针对此类患者情况,我们撕除覆?更多还原

【Abstract】 Objective To investigate an effective method for pupil dilation to facilitate phacoemulcification surgery in cataractous eyes with pupillary membrane secondary to old iridocyclitis, post anti-glaucoma surgery, ocular injury, and so on. Methods 32 patients with membranaceous microcoria covered by fibrous membrane in pupillary area and pupillary margin but without active inflammation were enrolled. A routine soleral tunnel incision and an auxiliary incision near the left superior limbus were made. Posterior iris synechia was dissected with a microspatula. Under the circumstances of normal-depth anterior chamber in the use of viscoelastic substance, fibrous membrane and strands in pupillary area, pupillary margin and posterior surface of iris were torn off with a pair of capsulorhexis forceps so that the iris was stretchy again. Results The membrane was torn off and the pupil was enlarged from 2-3 mm to 5~6 mm for all 32 patients successfully. Intraoperative complications were followed: dialysis of the root of the iris in 2 cases(6.25%), iris hemorrhage in 10 cases (31.25%), laceration of pupillary margin in 2 cases (6.25%). Post-operative complications includes: mild corneal edema in 4 cases (12.5%), exudation in anterior chamber and pupillary area in early stage in 8 cases (the exudates were absorbed after anti-inflammatory therapy and hot compress, and no epi-IOL membrane was remained), mild posterior capsule proliferation in 3 cases. After three-month duration of follow-up, partial posterior iris synechia was observed in 9 cases, of which the range of synechia was less than one third of pupillary margin in 7 cases, more than one third in 2 cases. All the IOL were well-positioned. 31 patients were followed up from 3 months to 32 months. Conclusion Tearing off the fibrous membrane covering pupillary area, pupillary margin and iris can recover iris elasticity, dilate pupil fully and naturally to meet the requirement of surgery. We can not only ensure CCC successfully but also get a physically round and active pupil post-operation. Enough viscoelastic substance, assistance of a microspatula, fluent and careful collaboration of both hands intra-operation, and daily pupil dilation post-operation are necessary for this maneuver. It is a convenient, economic and practical maneuver.更多还原