同轴微切口超声乳化系统在白内障手术中的临床应用

Clinical application of 2.2 mm micro-incision phacoemulsification in cataract surgery

目的对比研究2.2mm和3.0mm透明角膜隧道切口下应用扭动超声模式白内障超声乳化手术的手术效率和安全性。方法 90例年龄相关性白内障患者随机分为2组,每组45例,分别在2.2mm和3.0mm手术切口下利用扭动超声模式进行白内障超声乳化手术。术中记录累积释放能量、灌注液使用量;术后随访视力、角膜内皮细胞密度、中央角膜厚度以及角膜曲率。结果所有手术均无术中、术后并发症发生。累积能量释放在2.2mm组分别为:Ⅱ级核3.73±0.53、Ⅲ级核7.47±2.03、Ⅳ级核17.77±2.40,在3.0mm组对应分别为4.13±0.42、8.72±1.52、21.21±3.35,2组中同级别核硬度组之间比较,累积能量释放2.2mm组均小于3.0mm组,差异均有统计学意义(均为P<0.05)。术中灌注液使用量2组之间差异无统计学意义。角膜内皮细胞密度减少率,术后1周和1个月时在2.2mm组分别为0.08±0.07、0.10±0.07,在3.0mm组分别为0.11±0.06、0.13±0.06,2.2mm组均小于3.0mm组,差异均有统计学意义(均为P<0.05)。中央角膜厚度增加量在术后第1天,2.2mm组为(61±42)μm,3.0mm组为(76±56)μm,2.2mm组小于3.0mm组,差异有统计学意义(P=0.001),在术后1周和1个月2组之间差异无统计学意义。术源性散光在术后1个月,2.2mm组为(0.27±0.10)D、3.0mm组为(0.55±0.33)D,2.2mm组小于3.0mm组,差异有显著统计学意义(P<0.001)。术后不同时间点裸眼视力(LogMAR)2组之间差异均无统计学意义(均为P>0.05)。结论应用扭动超声模式白内障超声乳化手术,2.2mm手术切口较3.0mm手术切口组织损伤更小,术后恢复更快。

Objective To compare the effectiveness and safety of the torsional mode phacoemulsification through micro-incision（2.2 mm） and small incision（3.0 mm） in cataract surgery.Methods Ninety patients（90 eyes） with age-related cataract were randomized into two groups,45 cases in each group.One group underwent phacoemulsification using a torsional mode phacoemulsification through 2.2 mm corneal incisions,the other group using 3.0 mm corneal incisions.Intraoperative measurements included cumulative dissipated energy and balanced salt solution using.Post-operative measurements included endothelial cell counting,central corneal thickness,corneal curvature and best uncorrected visual acuity.Results There was no intraoperative and postoperative complication in all surgery.In the eyes with nucleus density grades of Ⅱ,Ⅲ,Ⅳ,the mean cumulative dissipated energy in the 2.2 mm group were 3.73±0.53,7.47±2.03,17.77±2.40,respectively,and in the 3.0 mm group were 4.13±0.42,8.72±1.52,21.21±3.35,respectively,there were statistical differences in same grade of nucleus density between two groups（all P0.05）.There was no statistical difference in balanced salt solution using between two groups（P0.05）.At postoperative 1 week and 1 month,the mean endothelial cell counting loss rate in the 2.2 mm group were 0.08±0.07,0.10±0.07,respectively,and in the 3.0 mm group were 0.11±0.06,0.13±0.06,respectively,there were statistical differences（all P0.05）.At postoperative 1 day,the central corneal thickness increase was（61±42） μm in the 2.2 mm group and（76±56） μm in the 3.0 mm group,there was significant difference（P=0.001）,but there was no statistical difference at postoperative 1 week and 1 month between two groups.At postoperative 1 month,the surgery-induced astigmatism was（0.27±0.10） D in 2.2 mm group and（0.55±0.33） D in 3.0 mm group,there was significant difference（P0.001）.However,there was no statistical difference in best uncorrected visual acuity at postoperative 1 day,1 week and 1 month between two groups（all P0.05）.Conclusion Phacoemulsification using the torsional mode through micro-incisions（2.2 mm） has less damage and more rapid recovery than that through small incision（3.0 mm）.