扭动模式和传统模式超声乳化白内障摘除术的临床研究

Comparative clinical study of phacoemulsification under torsional and conventional ultrasound mode

目的探讨扭动模式超声乳化在白内障吸除术中的安全性和有效性。方法选择2009年2月至2010年8月在眼科住院的年龄相关性白内障患者125例125只眼,按随机化原则分为扭动模式组和传统模式组2组。记录术中所使用的超声时间、累积释放能量,并于术后1天、7天及30天进行随访,比较术后最佳矫正视力,观察术后角膜水肿程度等指标。结果 1.平均累积释放能量:扭动模式乳化II级、III级、IV级核的平均累积释放能量分别为(4.12±1.92)%,(8.39±2.85)%,(15.91±7.36)%,传统模式组分别为(5.36±1.85)%,(9.80±3.40)%,(18.97±8.21)%,比较差异均有统计学意义(P<0.05)。2.平均超声时间:扭动模式组乳化吸除II级、III级、IV级核分别为(15.69±5.13)s,(27.98±10.12)s,(49.11±18.98)s,传统模式组分别为(20.36±5.32)s,(33.12±9.88)s,(58.56±15.36)s,差异均有统计学意义(P<0.05)。3.角膜水肿:术后1天及7天时,扭动模式组较常规模式组角膜水肿轻(P<0.05),术后1个月2组患者均无角膜水肿。4.视力:术后1天及术后7天最佳矫正视力≥0.5的患者扭动模式组多于传统模式组(P<0.05),而术后1个月后差异不明显(P>0.05)。结论扭动模式白内障超声乳化吸除术较传统模式对角膜内皮组织损伤更小,术后恢复更好,短期内即可获得良好的视觉效果,是一种高效安全的超声乳化模式。

OBJECTIVE To compare the efficiency and safety of age-related cataract surgeries performed with torsional mode and conventional ultrasound mode.METHODS In this comparative study,125 patients（125 eyes） diagnosed with cataract received surgery treatment from the same experienced doctor using Alcon infinity in our hospital from February 2009 to August 2010.The patients were divided randomly into two groups： 64 cases were in the Torsional group and 61 cases were in the conventional ultrasound group.All patients were assigned to phacoemulsification by an experienced surgeon.The intraoperative data of Ultrasound Time（UST） and Cumulative Dissipated Energy（CDE） were recorded and compared,and patients were followed up at 1,7,and 30 days after surgery.Postoperative outcomes as the change of the best corrected visual acuity（BCVA）,corneal clarity were also measured and compared.RESULTS For grade II,III,and IV nuclear density,mean CDEs were significantly lower in the Torsional group： mean CDEs were（4.12±1.92）%,（8.39±2.85）%,and（15.91±7.36）% respectively for the three grades in the Torsional group;（5.36±1.85）%,（9.80±3.40）%,and（18.97±8.21）% respectively in the Ultrasound group.There were statistical differences between these two groups（P0.05）.For grade II,III,and IV nuclear density,mean USTs were significantly shorter in the Torsional group： mean USTs were（15.69±5.13）s,（27.98±10.12）s,and（49.11±18.98）s for the three grades respectively in the Torsional group;（20.36±5.32）s,（33.12±9.88）s,and（58.56±15.36）s respectively in the Ultrasound groups.There were statistical differences between these two groups（P0.05）.Comparing the corneal clarity,the Torsional group showed significantly less corneal edema than the Ultrasound group in 1 day and 7days postoperatively（P0.05）.But at 30 days postoperative,there was no statistical difference between these two groups.The average best corrected visual acuity in the Torsional group was significantly better than that in the Ultrasound group 1 day and 7 days after operation（P0.05）.No statistical difference between these two groups was observed 30 days after operation.CONCLUSIONS Compared with the conventional mode,the Torsional mode could reduce the corneal endothelium damage during cataract extraction.It also showed a better postoperative recovery.Patients could get a good visual effect in a shorter period of time after operation.Therefore,the torsional mode was an effective and safe phacoemulsification mode,which had the value to promote in clinic.