微爆破模式对前房能量释放的影响

The influence of microburst mode upon anterior chamber energy release

目的探讨超声乳化白内障手术中微爆破模式对前房能量释放与超声时间的影响。设计前瞻性随机对照临床研究。研究对象老年性白内障患者211例(226眼),随机分为微爆破组105例(113眼)与常规连续超声组106例(113眼)。方法两组患者行超声乳化白内障手术,微爆破模式组爆破幅度为30ms,负压为220mmHg,超声能量为60%;连续超声模式组负压为210mmHg,最大超声能量为60%。主要指标术中有效超声能量、超声时间,术后第1天的最佳矫正视力、角膜水肿程度。结果微爆破组和连续超声组,核硬度Ⅰ～Ⅲ级时,术中有效超声能量分别为(3.52±1.58)%,(17.10±7.77)%;超声时间分别为(0.17±0.29)分,(0.99±0.57)分,差异均有统计学意义。术后第1天的最佳矫正视力≥0.5者分别为75眼(79.8%),62眼(65.3%)。核硬度IV～V级时,术中有效超声能量分别为(3.95±1.22)%,(17.33±8.06)%;超声时间分别为(0.25±0.28)分,(1.35±0.79)分,差异均有统计学意义。术后第1天的最佳矫正视力≥0.5者分别为9眼(47.4%),7眼(38.9%)。所有术眼术后第1天角膜水肿程度,微爆破组均较连续超声组轻微。结论在超声乳化白内障手术中,运用微爆破模式,对乳化吸除Ⅰ～Ⅲ级核具有优势;对于IV～V级核,联合拦截劈核技术,也能明显减少前房内能量的释放。

Objective To investigate the influence of microburst mode upon anterior chamber ultrasound energy delivery and the ultrasound time during phacoemulsification.Design Prospestive,randomized,comparative clinical study.Participants 211 age-related cataract patients (226 eyes).They were randomly divided into microburst mode group 105 patients ( 113 eyes)and continuous mode group 106 patients (113 eyes).Methods In microburst mode,the burst width was 30ms,the vacuum was 220 mmHg and the power was 60%.In the continuous mode,the vacuum was 210 mmHg and the max power was 60%.Main Outcome Measures The effective ultrasound power (USP),the ultrasound time (UST),the best corrected visual acuity (BCVA) and corneal edema on the first postoperative day.Results In grade Ⅰ～Ⅲ nuclei subgroup,USP were 3.52±1.58% in microburst mode group and 17.10±7.77% in continuous mode group respectively.UST were 0.17±0.29mins and 0.99±0.57mins,respectively.75 eyes(79.8%)in microburst mode group and 62 eyes (65.3%) in continuous mode group had BCVA better than 0.5 on the first postoperative day .The differences of USP,UST between two groups were statistically significant.In grade Ⅳ～Ⅴ nuclei subgroup,USP were 3.95±1.22% in microburst mode group and 17.33±8.06% in continuous mode group,respectively.UST were 0.25±0.28mins and 1.35±0.79mins,respectively.9 eyes (47.4%) in microburst mode group and 7 eyes (38.9%) in continuous mode group had BCVA better than 0.5 on the first postoperative day.The differences between two groups were statistically significant.No matter what grades the nuclear hardness was,the degree of corneal edema on the first postoperative day was slighter in the microburst mode group than that in the continuous group.Conclusions In phacoemulsification surgery,the microburst mode has advantages in nuclear hardness graded Ⅰ～Ⅲ.In nuclear hardness graded Ⅳ～Ⅴ,microburst mode combined with stop and chop techniques can also significantly reduce the anterior chamber energy release.