一种用于小瞳孔白内障超声乳化手术的自制一次性虹膜牵开器。
A self-made disposable iris retractor in small pupil phacoemulsification.
作者信息
Li Jie, Liu Fei, Zhang Wei-Wei, Zhang Jun-Jun
机构信息
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China ; Department of Ophthalmology, Nanhai Hospital, Southern Medical University, Foshan 528200, Guangdong Province, China.
Department of Ophthalmology, Nanhai Hospital, Southern Medical University, Foshan 528200, Guangdong Province, China.
出版信息
Int J Ophthalmol. 2014 Apr 18;7(2):288-92. doi: 10.3980/j.issn.2222-3959.2014.02.17. eCollection 2014.
AIM
To explore a simple and low-cost self-made disposable flexible iris retractor and study its clinical efficacy and safety in small pupil phacoemulsification.
METHODS
Polyproplyene suture and scalp acupuncture were used to make iris retractor. A prospective study were carried on 50 patients (50 eyes) with a maximally dilated pupil size of 2.5-4.0 mm which underwent phacoemulsification using this self-made iris retractor. Another 50 cases of phacoemulsification with normal pupil size sever as control group. The mean operation time, ultrasound time and ultrasonic power, volume of irrigation fluid were documented intraoperatively. The visual acuity, pupil size and complication were observed on 1d, 1wk, 1mo and 1y after operation. Corneal endothelial cell was measured at 1mo postoperatively.
RESULT
Pupils could be expanded to approximately 4.5-5.5 mm with our self-made iris retractor in operation. No serious postoperative complication was found. Most (88%) of the pupils returned round or oval shape, light reflex restored to varying degrees at the first day after surgery. Best corrected visual acuity stabilized in 37 eyes (74%) at one day, in 43 eyes (86%) at one week, in 44 eyes (88%) at one month and 46 eyes (92%) at one year. Compared with the control, more time was needed to complete the operation in the small pupil group. There was no significant difference of the mean ultrasound time, ultrasonic power, volume of irrigation fluid required and corneal endothelial cell loss in 1mo follow up between the two groups.
CONCLUSION
Our self-made disposable flexible iris retractor could be easy obtained preoperatively or intraoperatively. It performed both safety and efficacy in our clinical trials. This simple self-made device has shown economic and practical values, especially in primary care hospital of the less developed districts.
目的
探索一种简易、低成本的自制一次性软性虹膜拉钩，并研究其在小瞳孔白内障超声乳化术中的临床疗效及安全性。
方法
采用聚丙烯缝线和头皮针制作虹膜拉钩。对50例（50眼）瞳孔最大直径为2.5 - 4.0 mm的患者进行前瞻性研究，使用该自制虹膜拉钩行白内障超声乳化术。另50例瞳孔大小正常的白内障超声乳化术患者作为对照组。术中记录平均手术时间、超声时间、超声能量、灌注液量。术后1天、1周、1个月及1年观察视力、瞳孔大小及并发症情况。术后1个月测量角膜内皮细胞。
结果
术中使用自制虹膜拉钩可将瞳孔扩大至约4.5 - 5.5 mm。未发现严重术后并发症。术后第1天，大多数（88%）瞳孔恢复圆形或椭圆形，光反射不同程度恢复。最佳矫正视力在术后1天稳定的有37眼（74%），1周时43眼（86%），1个月时44眼（88%），1年时46眼（92%）。与对照组相比，小瞳孔组完成手术所需时间更长。两组在术后1个月随访时，平均超声时间、超声能量、所需灌注液量及角膜内皮细胞丢失量差异无统计学意义。
结论
我们自制的一次性软性虹膜拉钩术前或术中易于获取。在我们的临床试验中其兼具安全性和有效性。这种简易的自制装置显示出经济实用价值，尤其在欠发达地区的基层医院。
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