Blumenthal M, Assia E, Neuman D
Department of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer.
J Cataract Refract Surg. 1991 Mar;17(2):211-7. doi: 10.1016/s0886-3350(13)80252-0.
Preservation of the intact ("true") capsular bag, with no tears to the periphery, is essential to assure permanent in-the-bag fixation of the intraocular lens. Removal of a large nucleus using the open-system planned extracapsular cataract extraction (ECCE) technique is often associated with tearing of the capsulectomy or serious complications such as zonular rupture, vitreous loss, unintended intracapsular cataract extraction, or posterior lens prolapse. A closed-system planned ECCE technique which allows a safe removal of the lens while maintaining the integrity of the capsular bag is presented. Hydrodissection of the lens nucleus to an epinucleus and a central hard nucleus allows hydroextraction of the small hard core while pushing the posterior capsule backward. The positive pressure in the anterior chamber, provided by the anterior chamber maintainer, keeps the position of the lens steady in its natural location, and minimizes the stress on the zonular apparatus during nucleus delivery. The remaining epinucleus can be either hydroexpressed or aspirated. Fracturing the central core, when possible, enables removal of the lens material through a small limbal incision. Viscoelastic material can be combined with a low-flow, anterior chamber maintainer in a closed-system and provides a useful surgical tool.
保持完整的（“真正的”）囊袋，周边无撕裂，对于确保人工晶状体在囊袋内的永久固定至关重要。使用开放系统计划性囊外白内障摘除术（ECCE）技术取出大核时，常常会导致囊膜切开撕裂或出现严重并发症，如悬韧带断裂、玻璃体脱出、意外的囊内白内障摘除或晶状体后脱位。本文介绍一种封闭系统计划性ECCE技术，该技术可在保持囊袋完整性的同时安全地取出晶状体。通过水分离将晶状体核分离为核上皮质和中央硬核，这样在将后囊膜向后推的同时可水吸出小的硬核。前房维持器提供的前房正压可使晶状体在其自然位置保持稳定，并在娩核过程中使悬韧带装置上的应力降至最低。剩余的核上皮质可通过水挤出或抽吸去除。如有可能，将中央核劈开可通过小的角膜缘切口取出晶状体物质。在封闭系统中，粘弹剂可与低流量前房维持器联合使用，是一种有用的手术工具。
