手法扩张瞳孔术中不同瞳孔直径对瞳孔闭锁并发性白内障患者术后瞳孔功能的影响分析

摘要

目的：分析手法扩张瞳孔术中不同瞳孔直径对陈旧性葡萄膜炎引起的瞳孔闭锁并发性白内障患者术后瞳孔功能的影响。方法：按照手法扩张瞳孔术术中瞳孔扩张直径将85例（93眼）瞳孔闭锁并发性白内障患者分为扩瞳≥6.0 mm组42例（46眼）和扩瞳≤5.5 mm组43例（47眼），均行白内障超声乳化摘除联合人工晶体植入术治疗，术后随访3个月后对比不同瞳孔直径对术眼视力、角膜内皮细胞密度和手术并发症等方面的影响。结果：扩瞳≤5.5 mm组术后视力恢复显效率65.96%明显高于扩瞳≥6.0 mm组的45.65%（P<0.05）；两组均可导致角膜细胞丢失，术后角膜内皮细胞密度比较差异无统计学意义（P>0.05）；扩瞳≥6.0 mm组术中虹膜出血发生率45.65%、术后光反射迟钝或消失发生率71.74%均明显高于扩瞳≤5.5 mm组的23.40%、29.79%（P<0.01或P<0.05）。结论：手法扩张瞳孔术中扩瞳≤5.5 mm能够促进瞳孔闭锁并发性白内障患者术后瞳孔功能的恢复，降低手术并发症和角膜细胞丢失，在促进视力恢复和提高生存质量方面具有积极的作用，值得临床采取大样本和长时间随访对手术效果进行进一步验证。%Objective:To analyze the effects on intraoperative pupil dilation pupil diameter of the pupil function after surgery with the pupil atresia complicated cataract patients who caused by old uveitis in pupil dilation operation. Method:According to the way the pupil dilation diameter of intraoperative pupil dilation,85 cases(93 eyes)pupil atresia complicated cataract patients were randomly divided into and the pupil dilation≥6.0 mm group for 42 cases(46 eyes) and the pupil dilation≤5.5 mm group for 43 cases(47 eyes),they were treated with phacoemulsification with intraocular lens implantation,patients were followed up 3 months,the effects of different aspects of intraoperative pupil diameter on visual acuity,corneal endothelial cell density and complications of surgery between the two groups were compared.Result:Significant efficiency of the recovery of visual acuity after operation in the pupil dilation≤5.5 mm group was 65.96%,it was significantly higher than 45.65%of the pupil dilation≥6.0 mm group(P<0.05),the two groups could lead to loss of corneal cells,postoperative corneal endothelial cell density was no statistically significant difference(P>0.05).The incidence of intraoperative iris bleeding in the pupil dilation≥6.0 mm group was 45.65%,reflecting slow or disappear after the light incidence was 71.74%,they were significantly higher than 23.40%and 29.79%in the pupil dilation≤5.5 mm group(P<0.01 or P<0.05).Conclusion:The technique of intraoperative pupil dilation≤5.5 mm to dilate the pupil atresia can promote the recovery of patients with complicated cataract surgery pupil function,reduce surgical complications and loss of corneal cells, has a positive role in promoting visual recovery and improve quality of life,worthy of taking a large sample and long follow-up on the results of operations for further verification.