不同模式的超声乳化白内障吸除术治疗硬核白内障的临床效果

A Clinical effect on Phacoem ulsification cataract of different m odes in hard nucleus cataract

目的：探讨采用爆破模式与连续模式对硬核白内障患者行超声乳化白内障吸除术的临床效果。方法回顾性分析包头医学院第二附属医院眼科2012年3月至2013年6月收治的80例（84只眼）Ⅲ级硬核（EMERY分级）老年性白内障患者的临床资料，采用随机数字表法将患者分为爆破模式组39例（41只眼）和连续模式组41例（43只眼），分别采用爆破模式与连续模式实施超声乳化白内障吸除术联合后房型人工晶状体植入术。记录术中实际超声能量、有效超声时间和累计复合能量参数，检测患者术后视力、角膜水肿程度及角膜内皮细胞数。术后对患者进行3个月的随访。两组患者使用的超声能量和超声时间比较采用独立样本t检验；两组患者实施白内障术后的裸眼视力（UCVA）和最佳矫正视力（BCVA）比较，采用χ2检验。结果爆破模式组超声能量为（10．12±1．17）J，连续模式组超声能量为（16．30±1．36） J，两组超声能量比较，差异有统计学意义（ t＝23．362；P ＜0．05）；爆破模式组超声时间为（02．4±0．05）min，连续模式组超声时间为（0．70±0．11）min，两组比较差异有统计学意义（t＝23．727；P ＜0．05）；爆破模式组累积复合能量参数为（2．43±0．53）J，连续模式组累积复合能量参数为（11．45±2．07） J，两组比较，差异有统计学意义（ t＝27．029；P ＜0．05）。术后1 d，爆破模式组患者 UCVA≤0．3者8只眼（19．5％），UCVA 为0．4～0．5者17只眼（41．5％）， UCVA≥0．6者16只眼（39．0％）；连续模式组患者UCVA≤0．3者25只眼（58．1％），UCVA为0．4～0．5者10只眼（23．3％），UCVA≥0．6者8只眼（18．6％）；两组患者术后1 dUCVA比较，差异有统计学意义（χ2＝13．199；P ＝0．000）。术后3 d，爆破模式组患者UCVA≤0．3者0只眼，UCVA为0．4～0．5者9只眼（22．0％），UCVA≥0．6者32只眼（78．0％）；连续模式组患者UCVA≤0．3者5只眼（11．6％），UCVA为0．4～0．5者13只眼（30．2％），UCVA≥0．6者25只眼（58．2％）；两组患者术后3 dUCVA比较，差异有统计学意义（χ2＝6．543；P ＝0．038）。术后3个月，两组间BCVA差异无统计学意义（χ2＝4．385；P＝1．000）。爆破模式组与连续模式组术后1 d、3 d的角膜水肿减轻程度差异有统计学意义（χ2＝3．562，4．783；P＜0．05），术后1个月、3个月的角膜内皮细胞丢失率差异也有统计学意义（χ2＝7．308，8．298；P＜0．05）。结论爆破模式的超声乳化白内障吸除术对硬核白内障患者的角膜内皮细胞损伤较轻，术后视力恢复快，更具安全性及有效性。

Objective To evaluate and compare the effect of burst mode and continuous mode phacoemulsification on hard nuclei cataract.Methods A total of 80 cases (84 eyes) with nuclei density grade of Ⅲ ( according to EMERY classification ) from March 2012 to June 2013 in Department of Ophthalmology,the Second Affiliated Hospital of Baotou Medical College were retrospectively analyzed.They were randomly divided into burst mode group (39 cases,41 eyes) and continuous mode group (41 cases, 43 eyes) .Phacoemulsification surgery and intraocular lens implantation were implemented by using different ultrasonic energy pattern.The actual power ( AP) e,ffective phaco time ( EPT) t,he difference in accumulated energy ( APET) during surgery and corneal edema degree ,visual acuity and corneal endothelial cell number after surgery were recorded.Three-month followu-p was taken after surgery .Independent samples t test was used to evaluate the AP,EPT and APET.The vision and best corrected vision was assessed by chi-square test.Re suluts The AP was (10.12±1.17) in burst mode group and (16.30±1.36) in continuous mode group,and the difference was statistically significant (t=23.362;P <0.05).The EPT was (0.24±0.05) min in burst mode group and ( 0.70 ±0.11 ) min in continuous mode group, and the difference was statistically significant (t=23.727;P <0.05).The APET was (2.43 ±0.53) in burst mode group and (11.45±2.07) in continuous mode group,and the difference was statistically significant (t=27.029;P <0.05).On the first postoperative day,the vision of 8 eyes (19.5%) was≤0.3,17 eyes (41.5%) was 0.4-0.5,16 eyes (39.0%) was≥0.6 in burst mode group while the vision of 25 eyes (58.1%) was ≤0.3, 10 eyes (23.3%) was 0.4-0.5,8 eyes (18.6%)was≥0.6 in continuous mode group,the difference was statistically significant (χ2=13.199;P =0.000);On the third postoperative day, the vision of 0 eye was≤03., 9 eyes(22.0%)was 0.4-0.5, 32 eyes(78.0%) was≥0.6 in burst mode group while the vision of 5 eyes(11.6%) was ≤0.3, 13 eyes(30.2%) was 0.4-0.5, 25 eyes(58.2%) was≥0.6 in continuous mode group,and the difference was statistically significant(χ2=6.543;P=0.038) .But after three months the best corrected visual acuity between two groups showed no statistically significance(χ2=4.385;P>0.05). Corneal edema in burst mode group was significantly lighter than that in continuous mode group on the first and the third postoperative day(χ2=3.562,4.783;P<0.05).Compared with the continuous mode group,the rate of corneal endothelial cell loss was significantly lower in burst mode group one and three months after surgery respectively(χ2=7.308,8.298;P<0.05).Conclusions Compared with the continuous mode,burst mode phacoemulsification caused less corneal endothelial cell damage and faster visual recovery.It is more safe and effective.