不同部位白内障超声乳化术透明角膜切口构型及波前像差变化的研究

Changes of architecture and wavefront aberration of clear corneal incisions of phacoemulsification with different location

目的探讨白内障超声乳化术后不同部位透明角膜切口构型及角膜波前像差的变化。方法选择年龄相关性白内障患者91例(91眼右眼),依据切口位置不同分为2组,颞侧10∶00点钟位切口组,共46例(46眼),上方12∶00点钟位切口组,共45例(45眼)。术前1d、术后1周、1个月及3个月分别进行前节光学相干断层扫描,术后1个月及3个月进行裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)及角膜波前像差检查。应用SPSS13.0统计软件进行统计学分析。结果术后2组切口处角膜厚度、切口角度及切口长度差异均有统计学意义(均为P<0.05),术后近期切口区域内口哆开发生率差异均有统计学意义(均为P<0.05),术后1周2组上皮水泡、内皮水泡发生率的差异均有统计学意义(均为P<0.05);2组UCVA、BCVA、散光、慧差及三叶草差异均有统计学意义(均为P<0.05)。结论术后近期,白内障超声乳化术透明角膜颞侧切口较上方切口局部水肿轻,其构型更有利于形成密闭性切口,降低眼内炎的危险因素;远期颞侧切口所致手术源性散光小,角膜波前像差小,视觉质量好,是较理想的手术切口部位。

Objective To study the changes of architectural and wavefront aberration of clear corneal incisions（CCI）with different location after phacoemulsification.Methods Ninety-one patients（91 right eyes）with age-related cataract were chosen and divided into two groups based on different location,temporal incision at 1000 o＇clock group（46 eyes）and superior incision at 1200 o＇clock group（45 eyes）.The anterior segment optical coherence tomography（AS-OCT）was carried at preoperative 1 day and postoperative 1 week,1 month,3 months.The uncorrected visual acuity,best corrected visual acuity and corneal wavefront aberration were examined at postoperative 1 month and 3 months.The SPSS 13.0 software was used in statistical analysis.Results Between two groups,there were statistical differences in corneal thickness,incision length,and incision angle at the incision location（All P0.05）,statistical differences in endothelial gaping incidence at postoperative 1 week,1 month（All P0.05）,statistical differences in incidence of epithelial bubble,endothelial bubble and descemet detachment at postoperative 1 week（All P0.05）,statistical differences in uncorrected visual acuity,best corrected visual acuity,astigmatism,coma and trefoil（All P0.05）.Conclusions In the postoperative early stage,the edema of temporal CCI is less than superior CCI,the architectural of temporal CCI are more benefit to form the self-sealing incisions and decrease the risk for endophthalmitis;In the postoperative later stage,the astigmatism induced by surgery of temporal CCI is little,corneal wavefront aberration is small and the visual quality is good,which all suggest that the temporal CCI is the ideal surgery location.