2．2mm同轴微切口白内障超声乳化手术的早期临床效果评价

Clinical evaluation on the coaxial 2.2mm microincision phacoemulsification

目的对比2．2mm同轴微切口白内障超声乳化手术与3．0mm标准切口同轴超声乳化手术的早期临床效果。方法2011年6月至2011年11月行白内障超声乳化吸除联合人T晶体植入术的老年性白内障患者70例（70眼），随机分为2组：2．2mm组35例（35眼），3．0mm组35例（35眼），分别通过2-2mm微切口及3．0mm标准透明角膜切口行同轴超声乳化白内障吸除联合人T晶状体植入术（Alcon公司Infiniti），植入Alcon公司SN60WF人工晶状体。对比两种手术方式的术后早期视力，中央及切口部位角膜内皮细胞密度，角膜厚度，切口部位形态（内切口哆开、角膜后弹力层脱离），角膜水肿的影响。结果裸眼视力两组术后第l天差异无统计学意义（P=0．307），矫正视力术后1周及1月差异无统计学意义（P：O．816，0．91i）。中央角膜内皮细胞密度术后第1天，两组较术前均有明显下降，2．2mm组P=0．002，3．0mm组P=0．001，但两组间比较，中央角膜内皮细胞密度减少率的差异无统计学意义（P=O．456）；角膜切口内皮细胞密度减少率差异无统计学意义（P=0．820）。中央角膜厚度两组术后第1天增厚程度差异无统计学意义（P=0．821）。角膜切口厚度两组术后第1天，第1周及第2周时，与术前比较，差异均有统计学意义，但第3周时，2．2mm组差异无统计学意义（P=0．159），而3．011＇1111组，至1个月时，差异才无统计学意义（P=0．278）。角膜水肿率两组术后第1天，差异无统计学意义（P=0．307）。2．2mm同轴微切口组术后第1天内切口哆开率低于3．0mm组，P=0．040，同时内切口后弹力层脱离率低于3．0mm组，P=0．023。结论2．2mm同轴微切口超声乳化手术与3．0mm标准切口超声乳化手术相比，对角膜形态影响小，并发症发生机率减小，术后角膜切口愈合时间缩短，术后角膜伤口恢复更快。

Objective To compare the outcomes of coaxial 2.2mm microincision phacoemulsifiea- tion with standard coaxial 3.0mm clear corneal incision cataract surgery. Methods In this prospec- tive randomized study, 35 patients （35 eyes） had 2.2ram microincision phacoemulsification and 35 pa- tients （35 eyes） had 3.0mm standard coaxial phacoemulsifieation. Torsional mode of the Infiniti Vi- sion System was applied for the surgery. Visual acuity, endothelial cell density, cornea thickness and wound architecture were compared at intervals of 1 day, lweek, 2 weeks, 3weeks and 1 month after surgery. Results There was no significant difference on visual acuity between these two groups. There were no statistically differences in the lost rate of central/ wound area corneal endothelial cell density between two groups 1 day postoperatively. No statistically difference in central corneal thick- ness was found between the groups 1 day postoperatively. All incisions had slight corneal edema lim- ited to the incision area in the two groups. The increasing rate of the thickness of incision has the statistical difference 1 day, 1 week, 2 weeks postoperatively in both groups. There was no statistical-ly difference in 2.2mm group （P =0.159）, but there was statistically difference in 3.0mm group （P = 0.009） at 3 weeks postoperatively. There was no statistically difference in 3.0mm group until 1 month postoperatively. At 1 day the wound gape rate was lower in the 2.2mm group （P =0.040） and the Descemet membrane detachment rate was also lower in 2.2mm group （P =0.023）. Conclu- sions Compared to standard coaxial 3.0mm clear corneal incision cataract surgery, coaxial 2.2mm mi- croincision phacoemulsifieation had slightly fewer undesirable effects on the incision site. The 2.2ram microincision phacoemulsification could get earlier cornea rehabilitation postoperatively.Financial Dis- closure： No author has a financial or proprietary interest in any material or method mentioned.