挤切劈核法在囊膜上超声乳化手术中的应用

Application of crush-and-chop technique in supracapsular phacoemulsification

目的:探讨囊膜上挤切劈核法在白内障超声乳化手术中的应用。方法:年龄相关性白内障249例(289眼)随机分为囊膜上挤切劈核(crush-and-chop)组125例(147眼)和囊袋内拦截劈核(stop-and-chop)组124例(142眼)。分别在囊膜上和囊袋内原位采用挤切劈核和拦截劈核技术进行白内障超声乳化术。记录术中平均超声能量(AP)、实际超声乳化时间(U/Stime)、累积能量复合参数(AECP)、术中术后并发症、术后1d、1wk视力和术后1d角膜水肿等情况并进行比较。结果:将两组中同级核硬度的亚组进行比较,囊膜上挤切劈核组的AP、U/Stime、AECP均低于拦截劈核组,差异有显著性;且前者角膜水肿均轻于后者。两组术后1d裸眼视力囊膜上挤切劈核组优于拦截劈核组,术后1wk两组最佳矫正视力无差异。晶状体后囊膜破裂在囊膜上挤切劈核组有1眼,拦截劈核组中有3眼,无其他严重手术并发症。结论:囊膜上挤切劈核法操作简便,易掌握,且安全、有效。

AIM ： To study the effect of crush-and-chop technique in supracapsular phacoemulsification. METHODS： A total of 289 eyes of 249 patients with agerelated cataract were randomly divided into two groups. In crush-and-chop group, the crush-and-chop technique was performed in 147 eyes of 125 patients. In stop-and- chop group, the stop-and-chop technique was performed in 142 eyes of 124 patients. The main parameters including average power （AP）, U/S time, accumulated energy complex parameter （AECP）, intra-and postoperative complications, postoperative uncorrected visual acuity （UCVA） at 1 day, the best corrected visual acuity （BCVA） at 1 week and corneal edema were compared between the two groups. RESULTS： The subgroups with same grade of lens nucleus hardness were compared. Parameters such as AP, U/S time, AECP in crush-and-chop group were significantly less than those in stop-and-chop group. Postoperative corneal clarity in crush-and-chop group was better than that in stop-and-chop group. UCVA at 1 day in crush-and-chop group was better than in stop-and-chop group. No significant difference was found in BCVA at 1 week after operation between the two groups. Posterior capsule rupture occurred during operation in one eye in crush-and-chop group and three eyes in stop-and-chop group. There were no other severe intra- or postoperative complications. CONCLUSION： Crush-and-chop technique is easy, safe and effective in supracapsular phacoemulsification.