超声乳化能量、时间与眼压的关系及辅助切口放液治疗术后高眼压的临床研究

The clinical study about relationship of phaco power,ultrasound time and intraocular pressure and treatment of decreasing intraocular pressure viatappingfromadunctiveincision

目的探讨白内障超声乳化吸除术中超声能量、时间与术后早期眼压升高的关系,评价角膜缘辅助切口放液治疗术后早期高眼压的效果。方法年龄相关性白内障患者101例144眼随机分为软性人工晶状体(intraocularlens,IOL)植入组(简称软性IOL)和硬性人工晶状体植入组(简称硬性IOL组),又根据术后处理高眼压的方法不同分为辅助切口放液组(36眼)和药物治疗组(36眼),用Goldmann压平式眼压计测量术前、术后4—6h、术后24h各组眼压值。记录术中平均超声能量和超声时间,计算有效超声时间(effectiVephacotime,EPT)和眼压升高的百分数,用spearman等级相关估计眼压升高的百分率和EPT的关系。辅助切口放液组为结膜囊内滴表面麻醉剂后在裂隙灯显微镜下用一次性针头轻压角膜缘辅助切口后唇放出部分房水,比较与药物治疗组控制眼压的效果。结果软性IOL眼压升高与EPT分别是(55.11±74.17)%和6.61±3.71s,spearman等级相关系数为0.636,p<0.05;硬性IOL则是(42.32±68.92)%和4.61±3.10s,spearman等级相关系数为0.508,p<0.05。辅助切口放液组24h内眼压全部控制在正常,药物组需要3-4天完全控制眼压。结论白内障超声乳化吸除术中超声能量、时间与术后早期眼压升高具有相关性,角膜缘辅助切口放液治疗术后高眼压简单、安全、有效。

Objective To investigate the relationship of phaco power, ultrasougd time and immediate intraocular pressure（lOP）rise in phacoemulsification. To evaluate the effect of decreasing lOP after surgery via adjunctive limbus corneae incision. Methods This randomized study comprised 101 patients（144 eyes）with age-related cataract. The patients were divided into 2 groups： soft intraooular lens（IOL）group（soft IOL）and durus IOU The 2 groups were divided into adjurictive limbus corneae incision tapping（36 eyes）and drug treatment（36 eyes）. The lOP was measured preoperatively and postoperatively 4-6h and 24h after sugery with a Goldmann applabatioil tonometer. The intraoperative mean phago power and ultrasougd（US）time were noted. The effective phaco time（EPT）and percentage of IOP rise were calculated. The correlation between the EPT and percentage of rise in lOP was evaluated using Spearman＇s rank correlation. In adjunctive incision tapping group, polydocal was dropped into conjunotival sac, the posterior lip of adjunctive limbus corneae incision was pressed lightly to release some aqueous fluid with a disposable pinhead. To compare the change of lOP in 2 groups. Results The mean rise in IOP was（55.11 ± 74.17）% in the soft IOL group and（42.32 ±68.92）%in the durus IOL group, the mean EPT, 6.61 ±3.71 seconds and 4.61 ±3.10 seconds, respectively and the spearman＇s correlation coefficient was 0.636 （p〈0.05） and 0.508 （p〈0.05）. All pressures were normal in adjunctive incision tapping group in 24h and drug treatment group in 3-4d. Conclusion The rise in early lOP was correlated with the phaco energy and ultrasoulld time in phacoemulsification. Tapping from adjulletive limbus comeae incision was simple, safe and effective to decrease lOP after surgery.