扭动模式下旋转碎核与快速劈核的比较

Comparison of non-chopping rotation versus quick chop techniques in torsional mode

目的比较扭动模式下超声乳化自内障摘除术分别采用旋转碎核与快速劈核技术的效果。方法全部患者168例（180只眼）行扭动模式下超声乳化白内障摘除联合人工晶状体植人术，根据术中碎核方式，分为快速劈核组82例（90只眼）及旋转碎核组86例（90只眼）。记录超声时间和超声能量，术后视力、角膜厚度和角膜内皮细胞计数。结果对于Ⅱ、Ⅲ、Ⅳ级核，平均超声时间快速劈核组为23．24、38．74和63．89s，旋转碎核组为6．94、28．15和50．47s，差异有统计学意义；平均超声能量快速劈核组为11．87、16．26和28．86，旋转碎核为6．85、10．91和19．00，差异有统计学意义。术后角膜厚度：各级核术后1d旋转碎核组均低于快速劈核组，术后7d，Ⅱ、Ⅲ级核两组间差异无统计学意义，Ⅳ级核旋转碎核低于快速劈核组，术后30d差异无统计学意义。术后平均最佳矫正视力：各级核术后1d旋转碎核组较快速劈核组高；术后7d，Ⅱ、Ⅲ级核两组间差异无统计学意义，Ⅳ级核旋转碎核组高于陕速劈核组。术后30d差异无统计学意义。术后角膜内皮丢失：术后7d及30d，各级核旋转碎核组低于快速劈核组。结论扭动模式下超声乳化白内障摘除术中运用旋转碎核技术是安全且有效的方法。

Objective To compare the quick chop with non-chopping rotation phacoemulsification techniques in terms of efficacy and safety. Methods According to the phacoemulsification technique, 180 eyes of 168 patients with age-related cataract were randomly assigned to either phacoemulsification using quick chop technique or non-chopping rotation technique. The intraoperative outcomes of ultrasound time （UST） and cumulative dissipated energy （CDE） were recorded. Postoperative outcomes of best corrected visual acuity, corneal thickness and endothelial cell count were measured. Results For the grade 2, 3 and 4 nuclear density, the mean USTs recorded in quick chop group were 23.24, 38.74 and 63.89 seconds and in non-chopping group were 6.94, 28.15 and 50.47 seconds, respectively. The mean CDEs were 11.87, 16.26 and 28.86 in quick chop group and 6.85, 10.91and 19.00 in non-chopping groups, respectively. The corneal thickness showed signifi- cantly less corneal edema in non-chopping group at 1 day after surgery. At 7 days after surgery, there were no significant differences between the two groups for grade 2, 3 nuclear density, for grade 4 nuclear density, the corneal was thicker in quick chop group. At 30 days after surgery, those differences were not significant. The best corrected visual acuity of non-chopping group was better than quick chop group at lday after surgery. There were no significant differences between the two groups at 7 days after surgery for grade 2, 3 nuclear density, for grade 4 nuclear density, the best corrected visual acuity of non-chopping group was better. At 30 days after surgery, there were no statistical differences between these two groups. At 7 and 30 days after surgery, the endothelial cells in quick chop group were statistically lower than non-chopping group. Conclusions The non-chopping technique is advisable and effective for lens removal in the torsional mode phacoemulsification.