爆破与连续模式白内障超声乳化手术的效果比较

A clinical report on the use of brust mode phacoemulsification and continuous mode phacoemulsification

目的比较爆破与连续模式超声乳化术后视力恢复、眼内组织损伤情况。方法将243例（415只眼）白内障患者随机分为：连续组（A组194只眼），爆破组（B组221只眼），再根据晶体核硬度将两组患者分为1（Ⅱ级核）、2（Ⅲ级核）、3（Ⅳ级核）3个小组；比较各组实际超声时间，累计超声能量；术后1d、3d、7d最佳矫正视力；术后1d中央角膜厚度；术后1周、1个月、3个月中央角膜内皮细胞密度并观察前房反应及各种并发症。结果最佳矫正视力分布：第1d、3dA2组与B2组比较、A3组与B3组比较有统计学差异（P〈0．05）；第7dA3组与B3组比较有统计学差异（P〈0．05）。术中实际超声时间、累计超声能量B组较A组减少，有统计学差异（P〈0．05）。术后第1dB组较A组角膜厚度增加较少，有统计学差异（P〈0．05）。术后1个月、3个月A2组与B2组比较、A3组与B3组比较角膜内皮细胞丢失率有统计学差异（P〈0．05）。结论爆破超声能量模式可大大降低术中的能量释放，缩短手术时间，减少对角膜内皮的损伤，提高术后视觉质量。

Objective To compare the postoperative visual acuity and intraocular tissue injury of the patients underwent continuous mode and burst mode phacoemulcification.Methods 243 cases（415 eyes）were randomly divided into 2 groups：A was continuous mode （ 194 eyes） ;B was burst mode （221 eyes）.Each group was divided into 3 subgroups according to Emergy nuclear hardness： subgroup 1 had nuclear hardness of Ⅱ, subgroup 2 was Ⅲ and subgroup 3 was Ⅳ. Investigated the accurate ultrasound time , accumulated ultrasound energy, best visual acuity at 1st, 3rd, 7th postoperative day, central corneal thickness at 1st postoperative day, central corneal endothelial cell density at 1 st postoperative week and 1 st, 3rd postoperative month, presence of anterior chamber flare and complications during the follow-up. Results The best corrected visual acuity distribution of patients： there was significant difference in A2/B2,A3/B3 （P〈0.05） at the 1st and 3rd day; however at the 7th day only the A3 and B3 group was significantly different （P〈0.05）.The accurate ultrasound time and accumulated ultrasound energy in B group was significantly lower than A group （P〈0.05 ）.Thickness of central cornea of B group was significantly lower than that of A group （P〈0.05）.The loss percentage of corneal endothelial cell between A2 and B2, A3 and B3 were statistically different （P〈0.05）.Conclusions Using burst mode during phacoemulcification can reduce the ultrasound energy, shorten the operation time, decrease the damage to corneal endothelial cell and rise the postoperative visual acuity.