双手法微切口超声乳化白内障吸除联合人工晶状体植入术的临床效果评价

Clinical evaluation on the bimanual microincision cataract surgery

目的比较双手法微切口超声乳化白内障吸除联合人工晶状体植入术与常规同轴小切口超声乳化白内障吸除联合人工晶状体植人手术的临床效果。方法采用前瞻性随机对照研究，将280例（280只眼）白内障患者采用随机数字表法分为两组，分别行双手法微切口超声乳化白内障吸除联合人工晶状体植入术（微切口组，146只眼）和常规小切口超声乳化自内障吸除联合人工晶状体植入术（小切口组，134只眼）。分别记录两组超声乳化所用的超声乳化时间和平均功率，计算绝对超声乳化时间（绝对超声乳化时间=超声乳化时间×平均功率），检查患者术后1d和3个月的视力、角膜厚度、角膜内皮细胞计数及房水闪光值，以矢量法计算两组患者术后3个月的手术源性散光，并观察手术并发症。采用两均数t检验和Х^2。检验分别对计量资料和计数资料进行统计学分析。结果微切口组的超声乳化时间、平均功率以及绝对超声乳化时间分别为（0．76±0．36）min、10．93％±4．78％及（8．99±7．23）min，均明显低于小切口组（F=4．649，30．072，21．837；P〈0．05）。术后3个月，微切口组的手术源性散光[（0．37±0．32）D]显著低于小切口组[（1．28±0．77）D]，两组比较差异有统计学意义（F=68．331，P=0．000）。两组术后1d和3个月的视力、房水闪光值、角膜内皮丢失率和角膜增厚程度的差异均无统计学意义（P〉0．05）。结论双手法微切口超声乳化自内障吸除术可以降低超声能量释放，提高乳化效率，并可减少手术源性散光，提高手术疗效；但与传统同轴小切口超声乳化白内障吸除术相比，并未能进一步减少眼内组织损伤和炎性反应。

Objective To compare the outcomes of bimanual microincision phacoemulsification with conventional small incision cataract surgery. Methods A randomized prospective study of 280 consecutive cases （280 eyes ） was conducted. All patients were randomly assigned to receive bimanual microincision cataract surgery （MICS group） or small incision cataract surgery （SICS group）. The PHACO time （PT） and the average power （AP） were recorded, then absolute PHACO time （APT = PT × AP） was calculated. The differences in PT, AP, APT and BCVA between these two groups were compared. Visual acuity, anterior chamber flare value, thickened pachymetry and endothelial cells loss were recorded 1 day and 3 months after surgery. In addition, surgically induced astigmatism was analyzed. Results The mean FT, AP and APT of MICS group were significantly lower than those in the SICS group （ 0.76 ± 0. 36 ） min versus （0.87±0.49）min,10.93% ±4.78% versus 16.09% ±7.38% and （ 8. 99± 7. 23 ） min versus （15.27±12. 10）min, respectively （P 〈 0. 01）. At 3 months, the vertical astigmatic changes of MICS group was statistically lower than that of the SICS group [ （ 0. 37 ± 0. 32 ） D versus （ 1.28 ± 0. 77 ） D, P = 0. 000 ]. There were no significant differences in the visual acuity, anterior chamber flare value, endothelial cells loss and the thickened pachymetry at 1 day and 3 months after surgery between these two groups （ P 〉 0. 05）. Conclusions Bimanual microincision cataract surgery could significantly reduce PHACO power, enhance energy efficiency and reduce surgically induced astigmatism. However, MICS does not reduce surgical trauma and postoperative inflammation as compared to conventional SICS.