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Act Two-way chop phacoemulsification of hard nucleus cataract surgery_2657

By Virginia Franklin,2014-10-30 08:48
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Act Two-way chop phacoemulsification of hard nucleus cataract surgery_2657

    Act Two-way chop phacoemulsification of hard nucleus cataract surgery

     Abstract Objective: To investigate the law before and after the attack the two-way chop phacoemulsification of hard nucleus cataract surgery results. Methods: 219 cases (271)

    level and above to take before and after the attack from both sides hard-core cataract chop method, well-water separation

    and water stratification, smoking among hard-core pre-cortex

    and soft-core, after the first retreat emulsion on the edge of

    anterior capsule mouth, chop the nuclear device beneath the soft reduction, cessation of perfusion to the upper edge of the nuclear capsule with prolapse of anterior chamber shallowing pocket, emulsifying the nucleus at the edge of the first homeopathic resist, filling the anterior chamber deepened after the first slide into nuclear emulsion behind a nuclear device set chop the nuclear front, front and rear pincer attack on the nuclear splitting phacoemulsification broken. Results: The 271 hard-core have been successfully

    crushed an average of emulsifying time 57.4s, after 1d visual acuity ? 0.3 were 249 (91.9%), 1mo postoperative visual acuity was ? 0.5 235 (86.7%), ? 1.0 were 96 (35.4%).

    Conclusion: The hard nucleus cataract phacoemulsification

    crushed a two-way chop France's nuclear thorough, easy to operate, safe and effective, in order to crush hard-core of a

    good way.

     Key words cataract phacoemulsification chop hard core of nuclear technology

     Application of anteroposterior interceptive chop in

    phacoemulsification for hard nucleus cataract

     AbstractAIM: To evaluate the effect of anteroposterior interceptive chop in phacoemulsification for hard nucleus cataract.METHODS: Two hundred and seventy-one eyes of 219

    patients with hard nucleus cataract, grading level IV or V, were operated with anteroposterior interceptive chop method for splitting the nucleus, and then with phacoemulsification. RESULTS: The hard nucleus of the 271 eyes were successfully routed. The average phaco time was 57.4 s. Postoperatively,

    the number of patients with visual acuity ? 0.3 was 91.9% at

    postoperative 1 day, ? 0.5 in 86.7% patients and ? 1.0 in

    35.4% patients at postoperative 1 month.CONCLUSION: Anteroposterior interceptive chop for splitting nucleus in

    phacoemulsification is an effective, convenient and safe method to operate on hard nucleus cataract.

     * KEYWORDS: cataract; hard nucleus; phacoemulsification; anteroposterior interceptive chop

     0 Introduction

     Because the conditions people tend to wait until the

    fully mature cataract patients after the treatment, especially in medium and small cities and rural health conditions such as the relatively backward areas, so hard-core cataract accounts

    for a considerable proportion. Phacoemulsification cataract

    surgery, in order to reduce the hard core of the phaco energy and time, various pieces of nuclear methods [1-3] came into

    being. For example, block chop France [4] as well as horizontal chop method [5], squeezing cut chop and France [6],

    each has its advantages, but has its own common defect that is easy to damage the capsular bag chop sac bag, hard core at the bottom of difficult to split, there lingering phenomenon [4]. Therefore, we explored the clinical before and after the

    attack from both sides to deal with two-way chop

    phacoemulsification of hard nucleus cataract, after clinical verification of the method is simple, broken nuclear

    thoroughly, less complications, and save as much as possible the energy of ultrasonic emulsification and the time for

    another good way to scrap nuclear.

     An object and method

     1.1 objects from 2000-06/2006-06, using a two-way chop

    before and after the attack the hard-core implementation of

    the law 219 cases of phacoemulsification (271), in which men

    and 122 cases (152), female 97 cases (119 eyes). Age 62 ~ 92 (mean 73.3) years. Preoperative visual acuity from light perception to 0.2, according to face up to eye with intraocular lens implantation, a rigid posterior chamber intraocular lens implantation 193, folding lens 78. Lens nuclear hardness according to Emery standards: according to their color, and with reference to his age, were divided into five: I Class: powder white, congenital cataracts and 45 years of age; II Level: Nuclear yellow-white, 46 to 59-year-old

    under the posterior capsule-type cataract; III-class: nuclear

    yellow, including 60 ~ 90-year-old under the type of posterior

    capsular cataract; IV-class: nuclear-brown; V-class: Nuclear

    brown or black. This was no I, II, III-class nuclear; IV-class

    nuclear by 248; V-grade nuclear by 23.

     1.2 Methods preoperative preparation: 1 ~ 2d preoperative care 100 ? eyedrops (tobramycin) of eyes, 3 times / d, the rest prepared according to routine cataract surgery. Depending on the situation in patients with 4g / L times the promise hi topical anesthesia or 2g / L lidocaine 5mL for peribulbar anesthesia. Surgery was performed by one person to complete. Applications TOPCON Corporation surgical microscope, Japan, NIDEK phacoemulsification instrument, set the energy 50% ~ 70%, negative pressure 400 ~ 200mmHg (1mmHg = 0.133kpa). Do scleral tunnel incision and auxiliary incision. Healon filling the anterior chamber, capsulorhexis forceps continuous circular capsulorhexis 6mm in diameter, full of water

    separation and water layer, as emulsifying needle into the anterior chamber after lens nucleus in front of Gettering cortical or soft core, so that hard-core fully relaxed, the

    chopping device soft reduction of nuclear Below pouch pocket at the top of emulsifying head home, stop the infusion, so

    that the upper edge of nucleus prolapse as anterior chamber shallowing and the anterior capsule mouth, emulsion withstood the nucleus at the edge of the first advantage of the opportunity immediately after the infusion, so that the

    posterior capsule away from the Nuclear posterior pole, and then emulsifying the first stick to the back deep into the core of nuclear posterior pole, in front of the chop and nuclear devices form a "+" word cross-shaped, the two opposite

    force of nuclear attack from both sides split showed multiple small wedge-shaped pieces, emulsifying head Xi Zhu wedge broken emulsion of cutting-edge nuclear. The pieces of hard-

    core devices can also be used chop filled emulsifying head smash mouth squeeze more small, in order to

    Phacoemulsification. Removal of residual cortex, injected Healon in the pre-and post room, intraocular lens

    implantation, incision without suture.

     2 Results

     Follow-up 1mo, after 1d visual acuity ? 0.3 were 249

    (91.9%), 1mo postoperative visual acuity was ? 0.5 235

    (86.7%). The major complications: posterior capsular rupture in 6 (2.2%), by the preceding vitrectomy and intraocular lens implantation after ciliary sulcus fixation. Severe corneal edema in 4 (2 ~ 4wk recovery transparent). The average energy of 52% of phacoemulsification, phaco time 28 ~ 398 (average 57.4) s. Reposted elsewhere in the paper for free download http://

     3 Discussion

     Phacoemulsification cataract surgery in our country has undertaken more than ten years, the III level and below the soft-core processing easier, "flexible operation" and "divide and conquer method," can be a good soft-core crush gettering.

    But IV ~ V-class hard core of tackling more difficult cases, the invention also quite a number of ways: groove chop, horizontal chop, vertical chop, squeeze-cut chop, cut chop

    bite [7] and so on. These methods are effective, but there are some inadequacies, such as before the split core pieces, has

    paid a certain amount of ultrasonic energy, such as the case of IV ~ V-grade nuclear, core hard, time consuming and energy; often need high-vacuum to institute a fixed core, in order to chop the nuclear device can be placed in the nucleus or

    nuclear division or go around the equator He Xia; chop devices have to be through the anterior capsule between the mouth and nuclear front, around to the nucleus or nuclear behind the equatorial , visibility low, an increase of punctured posterior, anterior capsule tear the risk of injury; whether to split or break apart the nuclear, have often makes the rear of the nuclear lingering, negative nuclear float to the ultrasonic emulsification inconvenience. Moreover, often the posterior capsule and the suspensory ligament would have a greater pressure, ranging from posterior capsule rupture, while in suspensory ligament rupture to the nuclear fall into the vitreous cavity.

     The average age of a larger group of patients -73.3 years

    old, 1mo postoperative visual acuity ? 0.5 in 86.7%, ? 1.0

    were 35.4%, the proportion is relatively low, analysis may be older, often accompanied by some of the retinal lesions. Posterior capsular rupture in which four to six eyes just to use the law, is not so full before and after the infusion

    room, blindly back into the nuclear emulsion head on, this 4 was changed to give birth after the completion of its nuclear operations; the other two occurred in the suction involved when the result of residual cortex. Severe corneal edema in 4

    eyes, 2 eyes for glaucoma surgery patients, preoperative endothelial cell count is low; another two for the V-grade

    nuclear, despite the broken after phacoemulsification-core,

    still use a longer time, began to use 50% of the energy, the

    small pieces of nuclear can not be completely emulsified, often leading to duct obstruction, increase the energy to 70% after the small nuclear emulsion will be hard, but the large and compounded to scrap its nuclear energy around the room in the rotation, not easy to breathe emulsification header. So, for V-grade nuclear, using extracapsular extraction may be more appropriate.

     A two-way chop phacoemulsification method to deal with the hard core of several ways to overcome the aforementioned shortcomings, showing its advantages: (1) hard core before the

    split, almost without ultrasonic energy; (2 ) does not require high vacuum to Xizhu large and hard to bring the nuclear, which also overcomes the shortcomings of negative pressure machines weak. In the nuclear fully loose anterior capsule mouth again is large enough, chop soft reduction of nuclear lower nuclear device, hard-core will naturally tilt the upper

    part of prolapse anterior capsule mouth, super-homeopathic

    withstood the nuclear equatorial part of the nipple and

    immediately give perfusion, to prevent pre - Room totally

    disappeared; Querang posterior capsule away from the nuclear posterior pole, showing nuclear and cortex, or the gap between the posterior capsule, and then the emulsion under direct

    vision after the first ramp slipped close to the nuclear core in the posterior pole, and will not pierce the posterior capsule membrane emulsification first try to jack up the posterior pole in the nuclear core, played a "chopping block" role, stable and reliable. (3) chop nuclear apparatus in the nuclear front and the back of the nuclear emulsion was the first cross-shaped clamp firmly around the living core, extrusion, cutting, splitting handy, but also overcome the nuclear device blindly chop around to the danger of nuclear

    weeks. (4) The method the Department of surfaces at the same time in the nuclear augmentation before and after the nuclear nature is completely split, do not leave some residual body, for the subsequent super-milk float to create the conditions

    for nuclear. Of course, you can also post from the nuclear emulsion side facing the nuclear front, side with the chop pieces of nuclear devices, fill in the emulsification header. (5) two-way chop in the capsular bag is still broken line of

    nuclear, Needless to turn to anterior capsule on the nuclear and nuclear both before and after support had little impact on the suspensory ligament, especially in the nuclear emulsion after the first push up, even though posterior capsular rupture, nuclear units can not easily fall into the vitreous cavity.

     Attack from both sides before and after application of the law a two-way chop Note: (1) capsulorhexis I should be large enough, not less than 6mm, in order to smooth the upper edge of the nuclear Alice out before the capsule mouth. (2) try to suck in front of the net nuclear cortex and emulsion

    off the surface of the soft-core, that is, lysis of nuclear

    belted, to launch a pincer attack before and after the central

    core to create a space. (3) We must let the slide before the upper edge of the nuclear capsule mouth, another ultra nipple

    tip withstood the nuclear equator; have to wait at least before and after the infusion room, another ultra-nipples

    stick to slide into the nuclear core after the posterior pole, such as the Nuclear can not slide the upper edge of pouch can

    be made to the nuclear back into the Healon, so that the nucleus at the edge of exposed, again inserted after the nuclear emulsion head, can not be blindly head to Lever nuclear emulsion emulsion block in order to avoid injury of the posterior capsule . If you paid attention to the 3 o'clock, master, "before and after the attack the two-way chop

    Law" will be very easy to deal with hard core is also very efficient, reducing the risk factors for complications.

     References

     1 Shou-Zhi. Lens disease study. Beijing: People's Medical Publishing House ,2004:242-253

     2 WANG Ning, Wei Wenbin. Ophthalmology lectures. Zhengzhou: Zhengzhou University Press ,2005:155-158

     3 Xiao-Yang Liu. Phacoemulsification with small incision ECCE compare postoperative quality of life. International Ophthalmology, 2006; 6 (5) :1153-1155

     4 Yao Ke. Phacoemulsification technological progress and related issues. Chinese Journal of Ophthalmology, 2000; 36 (2): 85

     5 Li Zhang, Chen Wei, Rong Zhang, Xia Qing. Horizontal chop phacoemulsification. Chinese Journal of Practical Ophthalmology, 2001; 19 (5): 390

     6 Wang Shou-Yan, Zhang Yong. Packed chopped hard-core nature

    of nuclear technology in phacoemulsification cataract surgery applications. Ophthalmology research, 2001; 19 (4): 350

     7 EyeWorld Staff. Phacoemulsification using the "bite-cut -

    split" sub-core new skills. Asia-Pacific Cataract and

    Refractive Surgery Journal of Chinese Medical Association,

    2005; 1 (2): 27 reposted elsewhere in the paper for free download http://

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