Ophthalmology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2009;64(4):309-12. doi: 10.1590/s1807-59322009000400007.
To compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis.
This prospective comparative randomized study included two groups: the 1-CCC group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5-6 mm diameter, and the 2-CCC (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. Patients were stratified according to cataract subset, which was characterized echographically. Six patients were considered as type 1, fifteen as type 2 and three as type 3. Type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes.
With the one-stage technique, 46.15% of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53% of cases. Anterior capsule tears occurred in 23.07% of cases, discontinuity of capsulorhexis in 30.79% of cases and no posterior capsular rupture occurred. With the two-stage technique, leakage of the liquefied cortex occurred in 45.45% of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36% of cases. No anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. Considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3.
Two-stage continuous curvilinear capsulorhexis helps prevent unexpected radial tears of the initial capsulotomy from high intracapsular pressure, sudden radialization of the CCC and other intraoperative complications due to high intracapsular pressure, thus providing a safe cataract surgery in cases of white cataracts. These findings were supported by ultrasonography.
比较两种膨胀性白内障囊外摘除术中连续环形撕囊术的安全性：传统的一步法连续环形撕囊术和两步法连续环形撕囊术。
这是一项前瞻性的随机对照研究，包括两组：1-CCC 组（11 例）接受直径为 5-6mm 的传统一步法连续环形撕囊术，2-CCC 组（13 例）接受预先小的连续环形撕囊术，然后扩大或进行两步法连续环形撕囊术。根据白内障亚组的超声特征进行分层，亚组包括 6 例 1 型、15 例 2 型和 3 例 3 型。1 型包括皮质液化和广泛内部声反射的膨胀性白内障；2 型包括体积较大的核性白内障，少量白色实性皮质，最小的内部声反射；3 型包括纤维性前囊和少量内部回声尖刺的白内障。
在一步法中，46.15%的患者发生液化皮质漏；此外，61.53%的情况下，术者感觉到高眼内压。前囊撕裂发生在 23.07%的病例中，撕囊不连续发生在 30.79%的病例中，无后囊破裂。在两步法中，45.45%的病例发生液化皮质漏；此外，36.36%的情况下，术者感觉到高眼内压。无前囊撕裂、撕囊不连续或后囊破裂。考虑到每个白内障亚组，2 型的漏液发生率高于 1 型和 3 型。
两步法连续环形撕囊术有助于防止由于高眼内压引起的初始撕囊术的意外放射状撕裂、连续环形撕囊术的突然放射化和其他术中并发症，从而为白内障患者提供安全的白内障手术。这些发现得到了超声检查的支持。
