比较现代囊外摘出术与超声乳化吸出术对老年性白内障血-房水屏障功能的影响

Comparison of disorders of the blood-aqueous barrier after phacoemulsification and ECCE in cataract patients

目的比较老年性白内障现代囊外摘出术与晶状体乳化吸出术两种手术对眼血-房水屏障功能的影响。方法分别对32例(37眼)老年性白内障行经典的现代囊外摘出(10mm大切口)联合人工晶状体植入术以及60例(64眼)老年性白内障行超声乳化(3.2mm透明角膜切口)联合人工晶状体植入术,应用激光蛋白细胞检测仪定量检测手术前后房水蛋白浓度的变化。结果两组术前房水蛋白浓度差异无统计学意义(P>0.05),而术后各观察时期的房水蛋白浓度,差异均有统计学意义(P<0.05)。现代囊外摘出术组术后随访90d均高于术前,差异均有统计学意义(P<0.05);晶状体超声乳化组术后90d与术前比较,差异无统计意义(P>0.05)。结论比较白内障现代囊外摘出手术与晶状体超声乳化手术,前一种术式对血-房水屏障损伤较大,且血-房水屏障功能不能在短时间内修复。

Objective To evaluate and compare the anterior chamber inflammatory response after phacoemulsification with implantation of foldable intraoeular lens and after extraeapsular cataract extraction （ECCE） with implantation of unfoldable intraocular lens. Methods The aqueous protein concentration in 37 eyes of 32 patients after ECCE an 64 eyes of 60 senile patients who under- went phacoemulsification with intraocular lens implantation were ex- amined using a laser flare-cell meter. Quantitative measurements of anterior chamber aqueous protein concentration were performed preoperatively and on day 1, 7,30, and 90 after surgery. Results Aqueous flare mean photon counts in patients after ECCE and those after phacoemulsification were 7.18±1.38 and 6.94±2.34 before surgery （P 〈0.05） ;and increased to 32.60± 11.91 and 26.27± 10.21 on day 1 after surgery （P 〈0.05） ;then decreased to 19.83±6.46 and 13.96± 6.44 on day 7 after surgery （P 〈 0.05）;13.25±4.01 and 9.07±2.67 on postoperative day 30 （P 〈 0.05） ;eventually,the counting decreased to 9.53±3.25 and 7.16 ±1.89 on day 90 after surgery （ P 〈 0. 05 ）. In eyes with ECCE, highly statistically significant differences were found between preoperative flare values and those on days 1,7,30 and 90 after surgery while no statistically significant differences were found between preoperative flare values and those on days 90 after surgery in eyes after phacoemulsification. Conclusions For age-related cataract patients after ECCE,a more severe disorders of BAB was observed and a relative longer time for reestablishment of the blood-apueous barrier was required, while a short period after phacoemulsification.