【摘 要】
：
目的 评估32mm透明角膜切口超声乳化术治疗放射状角膜切开术(radial keratotomy,RK)后白内障的临床效果.设计回顾性病例系列.研究对象有放射状角膜切开手术史的白内障患者8例13眼,其中,RK角膜瘢痕为8刀者2例4眼,12刀者3例4眼,16刀者3例5眼.方法 由同一手术医师进行3.2mm透明角膜切口超声乳化+人工晶状体植入术.8刀RK组中,32mm透明角膜主切口位于相邻两条放射状角
【机 构】
：
首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科研究所,北京市眼科学与视觉科学重点实验室,北京市,100005
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目的 评估32mm透明角膜切口超声乳化术治疗放射状角膜切开术(radial keratotomy,RK)后白内障的临床效果.设计回顾性病例系列.研究对象有放射状角膜切开手术史的白内障患者8例13眼,其中,RK角膜瘢痕为8刀者2例4眼,12刀者3例4眼,16刀者3例5眼.方法 由同一手术医师进行3.2mm透明角膜切口超声乳化+人工晶状体植入术.8刀RK组中,32mm透明角膜主切口位于相邻两条放射状角膜瘢痕之间,未与瘢痕接触；12刀RK组中,主切口跨越1条角膜瘢痕；16刀RK组中,主切口跨越2条角膜瘢痕.于术后1天、1周、1个月、3个月、6个月、1年、2年和3年进行随访,观察角膜RK瘢痕情况、并发症处理及术后视力恢复情况.主要指标有无RK瘢痕裂开、术后最佳矫正视力、角膜散光、角膜内皮细胞密度.结果 8刀RK组和12刀RK组术中均末发生角膜RK瘢痕裂开,术毕切口密闭良好；16刀RK组,其中3眼末发生术中角膜瘢痕裂开,2眼发生术中角膜瘢痕裂开,1眼采用前房注气封闭切口,另1眼采用主切口下注入粘弹剂,侧切口前房注气封闭切口.术后随访时间最短为1个月,最长为3年.随访过程中,所有13眼术后角膜切口密闭良好,均末出现新发角膜瘢痕裂开.最后1次复查时,最佳矫正视力为(0.67±0.18)较术前(0.29±0.20)提高(t=-6.077,P=0.000),角膜散光(1.69±1.23D)较术前(1.28±0.78D)无明显变化(t=-0.758,P=0.470),角膜肉皮细胞密度(1716.95±906.79/mm2)较术前(2383.97±833.39/mm2)降低(t=2.995,P=0.012).结论 8刀、12刀RK术后白内障患者行超声乳化+人工晶状体植入术时采用32mm透明角膜切口比较安全,16刀者采用32mm透明角膜切口术中容易发生角膜瘢痕裂开,建议采用更小的角膜切口或采用传统的角巩膜隧道切口.
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