软壳技术在成熟期白内障手术中的应用

Application of the soft-shell technique in cases with the mature cataract

目的 评价软壳技术在成熟期白内障手术中降低角膜内皮损伤的有效性和安全性。方法 对5 9例75眼成熟期白内障患者行超声乳化白内障吸除联合人工晶状体植入术,其中37眼使用DuoVisc产品(软壳组) ,38眼使用透明质酸钠(对照组) ,观察比较两组术后视力、角膜内皮计数和并发症。结果 软壳组与对照组最佳矫正视力≥0 . 5在术后1周分别为91. 9%和71. 1% ,两组有显著性差异(P <0 . 0 5 ) ;在术后1月分别为97 .3%和92 . 1% ,两组无显著性差异(P >0 . 0 5 )。软壳组与对照组术后1月角膜内皮细胞丢失率分别为5 . 3%和14 . 9%。软壳组角膜内皮计数术后1月与术前无显著性差异(P >0 .0 5 ) ;对照组角膜内皮计数术后1月与术前有显著性差异(P <0 . 0 1)。软壳组和对照组术后第1天发生角膜水肿分别为13眼和2 8眼,术后1周无角膜水肿;两组术后第1天房水闪光均高于术前水平,1周内逐渐减轻,两组之间房水闪光无明显性差异(P >0 . 0 5 )。两组未发生其他严重并发症。结论 软壳技术在成熟期白内障手术中应用具有保护角膜内皮、提高手术安全性。

Objective To evaluate the efficacy and safety of the soft-shell technique in reducing corneal endothelial cell damage during cataract surgery in patients with the mature cataract.Methods Seventy five eyes qof 59 patients with the mature cataract had phacoemulsification with intraocular lens(IOL)implantation,including 37 eyes using the soft-shell technique with DuoVisc(Viscoat+ProVisc)(soft-shell group),and 38 eyes using sodium hyaluronate(control group).The visual acuity,corneal endothelial cell density,and complications were evaluated postoperatively.Results 91.9% and 71.1% patients obtained corrected visual acuity ≥0.5 in the soft-shell group and the control group respectively 1 week after operation,the difference being statistically significant(P<0.05).One month after operation,there were 97.3% in the soft-shell group and 92.1% in the control group,and the difference was not statistically significant(P>0.05).The rate of corneal endothelial cells 1 month after surgery was 5.3% in the soft-shell group and 14.9% in the control group.13 eyes in the soft-shell group and 28 eyes in the control group occurred corneal edema 1 days after surgery,and the difference between the two groups was no statistically significant in flare intensity in the anterior chamber(P>0.05).The corneal edema gradually reduced and the flare intensity returned to preoperative levels 1 week after surgery in either group.No other serious complications were observed in this series.Conclusions The soft-shell technique is a safe and effective in protecting corneal endothelial cells during cataract surgery in patients with the mature cataract.