白内障超声乳化术中扭动模式与传统爆破模式的临床研究

Comparison of torsional mode and conventional ultrasound mode phacoemulisification for cataract surgery

目的比较并探讨扭动模式与传统爆破模式对白内障超声乳化术后的影响。方法前瞻f生随机对照研究。对2008年1月至2009年1月在上海交通大学医学院附属第九人民医院按照手术日登记将接受白内障超声乳化手术的患者随机分为2组，扭动模式组94例，传统爆破模式组94例，分别使用扭动模式和爆破模式进行超声乳化手术。术中记录超声时间（Ultrasound Time，UST），累计分散能量（Cumula—tive Dissipated Energy，CDE）和手术并发症。患者术后1周、1月、3月接受复诊和随访。术后检查项目包括最佳矫正视力和角膜内皮计数。结果根据Emery白内障核分级：扭动组I＋II、III、IV级以上核的超声时间分别是（31．06±14．29）s、（35．72±19．74）s、（74．11±41．50）s；爆破组I＋II、III、IV级以上核的超声时间分别是（47．3±17．58）s、（53．34±19．51）s、（84．54±15．45）s，两者之间差异有统计学意义（F值分别为3．845、5．643、7．814，P〈0．05）。扭动组I＋II、III、IV级以上核的CDE值分别是11．2±5．33、12．42±5．49、18．19±1.31；爆破组I＋II、III、IV级以上核的CDE值分别12．65±5．71、15．64±9．35、42．5±3．01，两者间差异有统计学意义（F值分别为8．800、9．386、9．388，P〈0．05）。手术3月的最佳矫正视力扭动组O．72±0．21，爆破组0．70±0．18，两者间无明显差异（P〉0．05）。术后1周、1月、3月的角膜内皮细胞计数，扭动组分别为（2149±199）、（2222±177）、（2313±161）个／mm^2爆破组分别为（2055±218）、（2084±175）、（2259±179）个／mm2，各组间差异有统计学意义（F值分别为6．297、6．272、5．957，P〈0．05）。结论白内障超声乳化手术中采用扭动模式可以有效减少能量和缩短时间，减轻患者角膜内皮的损伤，是一种安全有效地手术模式。

Objective To compare the intraoperative and postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System. Methods Randomized comparative study. A total of 188 eyes were assigned to phacoemulisification by torsional mode or conventional ultrasound mode according to the appointed day. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time （UST）, cumulative dissipated energy （CDE）, and surgical complication. Patients were seen 7, 30, and 90 days after surgery. Postoperative outcome measures were the final best corrected visual acuity （BCVA） and the change in endothelial cell count. Results The US group had 94 eyes and torsional group 94 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of I±II, III, IV and above, the mean UST was 31.06± 14.29 s, 35.72± 19.74 s, 74.11± 41.50 s, respectively in the US group and 47.3± 17.58 s, 53.34± 19.51 s, 84.54± 15.45 s respectively in the torsional group （P 〈0.05）; the mean CDE was 11.2± 5.33, 12.42± 5.49, 18.19± 1.31 respectively in the US group and 12.65±5.71, 15.64±9.35, 42.5± 3.01 respectively in the torsional group （P 〈0.05）. Postoperative 90 days, the mean BCVA were 0.72± 0.21 in torsional group and 0.70±_ 0.18 in US group （P 〉0.05）. At 7 days, 30 days and 90 days, the mean central corneal endothelial cell count was 2149± 199, 2222± 177, 2313± 161 respectively in the US group and 2055± 218, 2084± 175, 2259± 179 respectively in the torsional group （P 〈0.05）. Conclusions The torsional mode can provide more effective lens removal with a lower level of phacoemulsification time and energy.