同轴微小切口超声乳化吸出术在青光眼滤过术后白内障摘出术中的应用

Coaxial microincision phacoemulsification for cataract after glaucoma filtering surgery

目的比较同轴微小切口与标准切口超声乳化吸出术(phacoemulsification,Phaco)在抗原发性闭角型青光眼(primary angle closure glaucoma,PACG)滤过术后白内障摘出的安全性与有效性。方法连续收集抗PACG滤过术后白内障患者46例(46眼),其中研究组行同轴微小切口(2.2mm透明角膜切口)Phaco26例(26眼),对照1组行标准切口(3.0mm透明角膜切口)Phaco20例(20眼),另设对照2组为单纯老年性白内障行2.2mm同轴微小切口Phaco50例(50眼)。所有病例均采用扭动模式行超声乳化术,记录术前白内障核分级,术前最佳矫正视力(best corrected visual acuity,BCVA)、眼压(intraocular pressure,IOP)、中央前房深度(central anterior chamber depth,ACD)、晶状体厚度(lens thickness,LT)、角膜内皮细胞计数(endothelial cell count,ECC)、眼轴长度(axial length,AL)及术中累积消散能量(cumulative dissipated energy,CDE)和灌注液消耗量(estimated fluids used,EFU),同时记录术后1d、7d、30d的BCVA、IOP、角膜水肿程度及术后30d的ECC值等。结果各组白内障均以3级核为主,术眼生物学参数分析显示,研究组的ACD值与AL值均小于对照2组,差异均有统计学意义(均为P=0.00)。研究组的LT值则略高于对照2组,差异无统计学意义(P=0.07)。研究组术中CED及EFU均低于对照1组,差异均有统计学意义(均为P<0.05)。术后BCVA分析,术后1d≥0.5的眼数,研究组占38.5%,高于对照1组的20.0%,但差异无统计学意义(P=0.11)。对术后角膜水肿程度分析发现,术后1d,研究组以1级水肿为主,对照1组则以2级水肿为主,两组间差异有统计学意义(P=0.03)。术后30d,各组ECC值均显著低于术前,研究组与对照1组分别较术前减少38.9%和52.5%,对照2组减少9.8%,其中研究组与对照1组的术前、术后差值比较差异有统计学意义(P=0.00)。结论同轴微小切口超声乳化术前房稳定性好,可以显著减少超声能量,缩短超声乳化时间,减少术中灌注液的用量,降低术后角膜内皮细胞丢失率,促进视力的迅速恢复,适用于青光眼滤过术后的白内障摘出术。

Objective To compare the safety and efficacy of coaxial microinci- sion and standard incision phacoemuisification for cataract after primary angle closure glaucoma （PACG） filtering surgery. Methods Forty-six cases （46 eyes） with cata- racts after PACG filtering surgery were prospectively comprised in this study. All cases were divided into two groups randomly. Study group（2.2 mm coaxial mlcroincision ） in- cluded 26 cases. Control group 1 （ 3.0 mm incision） included 20 cases. Control group 2 （2.2 mm coaxial microincision, age related cataract） included 50 cases. All cases were received torsional mode phacoemulsification. Preoperative measurements included cata- ract nuclear grade, best correct visual acuity （ BCVA）, intraocuiar pressure （ IOP ）, cen- tral anterior chamber depth （ ACD ）, lens thickness （ LT）, endothelial cell count （ ECC ） and axial length（AL）. Intraoperalive measurements included cumuiative dissipated en- ergy （CDE） and estimated fluids used （EFU）. Postoperative measurements at l day, 7 days and 30 days included BCVA,IOP and corneal edema. Results The cataract nu- cleuses in all patients were mainly in grade Ⅲ. The ACD and AL in study group were lower than in control group 2, there were significant differences （ both P = 0.00 ）. The LT in study group were higher than that in control group 2, there was no statistical difference （P = 0.07）. The CDE and EFU in study group were lower than that in control group 1 ,there was statistical difference（P 〈0.05）. The percentages of BCVA more than 0.5 at 1 day after opera- tion in study group and control group 1 were 38.5% and 20.0% , but there was no statistical difference （P = 0.11 ）. The cor- neal edema at 1 day after operation in study group and control group 1 were mainly in grade 1 and grade 2, respectively, there was statistical difference（P =0.03 ）. ECC at 30 days after operation were all lower than that before operation,the re- duction of study group,control group 1 and 2 were 38.9% ,52.5% and 9.8% ,there was significant difference in ECC reduc- tion between study group and control group 1 before and after operation（P =0.00）. Conclusion The coaxial nficroinci- sion phacoemulsifieation has well anterior chamber stability, can reduce the CDE,EFU and ECC,shorten the surgical time and yield the good visual outcomes,indicating the value of coaxial microincision in emulsifying cataracts after glaucoma filtering surgery.