双刀水平面二次劈核与超声乳化治疗硬核白内障的对比研究

Comparative Study of Using Two-knife Plane Double Chopping Technique and Foldable intraocular Lens(FIOL) Implantation with Phacoemulsification in Hard Nucleus Cataract Surgery

目的比较双刀水平面二次劈核折叠晶体植入与超声乳化手术治疗硬核白内障的疗效、并发症。方法97例118眼Ⅳ级以上硬核白内障患者,随机分成双刀水平面二次劈核手术(劈核组)47例56眼,超声乳化手术(超乳组)50例62眼。超乳组能量设定45%～60%,负压130～140mmHg,平均超声能量(28.73±3.54)%,平均超声时间(127.35±51.46)s。两组术后随访时间6个月。结果术后3d视力恢复,劈核组优于超乳组(P=0.04),90d视力恢复两组间差异无显著性(P=0.69)。术后角膜水肿发生率,劈核组轻度占8.29%(5/56),超乳组轻度8.06%(5/62),中度20.97%(13/62),两组总角膜水肿发生率比较差异有显著性(8.29%vs33.87%,P<0.05)。两组术后3d及90d平均角膜散光度比较差异无显著性(P>0.05)。结论劈核组术后早期视力恢复快、角膜水肿发生率低,明显优于超乳组。提示双刀水平面二次劈核治疗硬核白内障疗效可靠、并发症少,值得推广。

[Objective]To compare the effects and complications of using two-knife double chopping tech- nique with FIOL implantation（non-phacoemulsification small-incision cataract surgery）and phacoemulsification in hard nucleus cataract surgery. [Methods]One hundred eighteen eyes of 97 patients with hard nucleus（harder than Grade Ⅲ ） cataract were divided into two-knife chopping nucleus technique group（56 eyes of 47 patients） and phacoemulsification group（62 eyes of 50 patients）randomly. The energy in phacoemulsification group was set 45%～60%. The negative pressure was 130～140 mmHg. The average phacoemulsification energy was （28, 73±3.54）%. The average phacoemulsification time was （127.35 ± 51.46）s. All patients were followed up for six months. [Results]The third day after surgery, the visual acuity was recovered. Two-knife chopping nucleus technique group was better than phacoemulsification group （ P =0.04） . In the third month after surgery, there was no statistically significant difference between the two groups in visual acuity （ P =0.69）. Five of 56 （8.29%） patients in two-knife chopping technique group had mild corneal edema. Five of 62 （8.06%） patients in phacoemulsification group had mild corneal edema. Thirteen of 62 （20.97%） patients in phacoe- mulsification group had moderate corneal edema,there was statistically significant difference in edema of two groups （ P = 0.03）There was no statistically significant difference in average astigmatism between the two groups in the third day and the third month after surgery （ P =0.71）. [Conclusion]The patients of cataract in two-knife chopping nucleus technique group has quicker recovery of visual acuity and less corneal edema than those in phacoemulsification group at early stage postoperatively,such method had reliable effect ,less complications ,thus it deserves recommendation.