双手微切口白内障超声乳化手术的临床效果观察

Clinical outcomes of bimanual micropulse cataract phacoemulsification

目的观察双手微切口白内障超声乳化手术的临床效果,并与同轴冷超声乳化术以及传统同轴超声乳化手术进行比较。方法56例(80眼)年龄相关性白内障患者随机分为3组:A组行双手微切口冷超声乳化术,B组行同轴冷超声乳化术,C组行传统超声乳化术。术后1d、1周和3个月随访,比较超声能量、手术造成的散光改变及角膜内皮细胞密度改变。结果术后各组角膜内皮细胞密度之间差异无统计学意义(F=0.48,P>0.05);A组等效超声乳化时间(EPT)最短,A、B组与C组之间EPT的差异有统计学意义(F=9.77,P<0.05);三组的平均超声乳化能量分别为6.42%、6.0%和15%(F=43.36,P<0.05);手术造成的散光改变各组间差异无统计学意义。结论冷超声乳化术与传统超声乳化术相比,所需能量和EPT更少。双手微切口手术与同轴手术相比没有造成更多的角膜灼伤。

Objective To compare the clinical outcomes of bimanual micropulse phacoemulsification （cold phaco） with IOL implantation to monomanual cold phaco and to conventional phaco in uncomplicated cataract surgery.MethodsEighty eyes of 56 patients with cataract were randomized into three groups.Group A underwent bimanual cold phacoemulsification,group B underwent monomanual cold phaco and group C underwent conventional phaco.The phaco power used in each procedure,postoperative astigmatism change,best corrective visual acuity,corneal endothelial cell loss rate and corneal hexagon cell rate were assessed among different groups.Follow-up was carried out in 1 day,1 week and 3 months.ResultsNo statistically significant difference was found in corneal endothelial cell density among three groups（F=0.48,P〉0.05）.No rupture of posterior capsule,secondary glaucoma,iridocyclitis or other severe postoperative complications were seen during the follow-up period.The equivalent phaco time （EPT） was least in the bimanual cold phaco group,and the EPT was significantly decreased in group A and B compared with group C（P〈0.05）.Average phaco power was 6.42%,6.0% and 15% in group A,group B and group C respectively with a significant difference（P〈0.05）.Astigmatic change after surgery was most obvious in group C（0.49D） and the least amount in group A （0.32D） without statistically significant difference between them（P〉0.05）.ConclusionMicropulse technique takes less power and equivalent phaco time than the conventional phaco technique during the operation.Bimanual phaco does not have dominant advantage over monomanual phaco.Compared to conventional phaco,a smaller incision in bimanual phaco can decrease the surgery-induced postoperative astigmatism.