三种透明角膜切口白内障超声乳化术疗效分析

Analysis of therapeutic effect of phacoemulsification through 3 different clear corneal incisions

目的前瞻性研究常规正上方切口、颞上方切口以及角膜地形图引导下角膜切口白内障手术的疗效。方法接受透明角膜切口白内障超声乳化术的患者111例120眼,随机均分为角膜地形图引导下白内障手术透明角膜切口(切口位于角膜最大屈光轴方向,A组)、颞上方切口(B组)和正上方切口(C组)3组。检测术前及术后1周、1个月、3个月角膜散光度和视力变化。结果术前和术后1周,3组间裸眼视力的差异无统计学意义(P值均>0.05);而术后1个月和3个月A组裸眼视力显著优于B、C组(P值均<0.05),而B组与C组间的差异无统计学意义(P值均>0.05)。A组术前及术后1周、1个月、3个月的角膜散光度分别为(0.97±0.35)、(1.21±0.32)、(1.17±0.26)、(1.03±0.27)D,B组分别为(1.03±0.19)、(1.56±0.37)、(1.54±0.37)、(1.37±0.28)D,C组分别为(1.05±0.24)、(1.52±0.13)、(1.48±0.10)、(1.29±0.13)D,A组在术后1个月和3个月的角膜散光度显示著小于B、C组(P值均<0.05)。B组超声乳化时间显著短于A、C组(P值均<0.05)。结论角膜地形图引导下位于角膜最大屈光轴方向的切口有助于控制术后散光和视力恢复。颞上方角膜切口利于操作。

Objective To investigate the therapeutic effect of phacoemulsification through 3 different corneal incisions （superior incision, temporal incision and incision guided by corneal topography system）. Methods Totally 120 eyes underwent phacoemulsification with corneal incision were randomly divided into 3 groups （n=40） ： group A （incision at the steepest corneal meridian as guided by corneal topography system）, group B（temporal incision） and group C（superior incision）. The changes of corneal astigmatism and uncorrected visual acuity were determined before and 1 week, 1 month and 3 months after operation. Results Five eyes were lost during follow-up. Group A had 35 patients （38 eyes）, group B had 37 patients （40 eyes） and group C had 35 patients（37 eyes）. The uncorrected visual acuities were similar between the 3 groups before and 1 week after operation （P〉0.05）. One month and 3 months after operation, the visual acuities in group A were better than those of the Group B and C （both P〈0. 05）; and there was no significant difference between the latter 2 groups. In group A the astigmatisms were（0.97±0.35） , （1.21±0.32）, （1.17±0.26） and （1.03±0.27） D before, 1 week, 1 month, and 3 months after operation, respectively; in group B the numbers were（1.03±0.19）,（1.56±0.37）,（1.54±0.37）, and （1.37±0.28） D, respectively, and in group C were（1.05±0.24）, （1.52±0.13）, （1.48±0.10） and （1.29±0.13） D, respectively. One month and 3 months after operation, the astigmatism in group A was lower than in group B and group C （all P〈0.05）. The phacoemulsification time in group B was shorter than those in group A and C （P〈0.05）. Conclusion The incision at the steepest corneal meridian guided by corneal topography system can reduce post-operation astigmatism and improve visual acuity. The temporal side incision is easy to perform.