不同切口超声乳化人工晶状体植入术治疗高度近视合并白内障的疗效比较

Clinical effect comparison of phacoemulsification with different incision on high myopia-combined cataract

目的比较不同切口白内障超声乳化人工晶状体植入术治疗高度近视合并白内障的临床疗效。方法回顾性分析我院2009年1月至2010年6月行超声乳化人工晶状体植入术的高度近视合并白内障患者42例(50眼)的临床资料,根据术中切口选择不同分为两组,其中A组选择透明角膜切口,B组选择改良巩膜隧道切口。术后随访3～6个月,分别于术前、术后3d、1个月、3个月观察两组患者中央角膜厚度、术源性散光、角膜内皮细胞计数等,观察术后3个月两组BCVA,同时观察术中、术后并发症发生情况。结果与术前相比,术后3d、1个月、3个月两组CCT均明显增加,差异均有统计学意义(均为P<0.05);术后3dB组CCT低于A组,差异有统计学意义(P<0.05);术后1个月、3个月两组CCT差异均无统计学意义(均为P>0.05)。A、B组术后1d术源性散光分别为(0.64±0.25)D、(0.36±0.14)D,术后1个月分别为(0.51±0.26)D、(0.28±0.12)D,术后3个月分别为(0.48±0.18)D、(0.27±0.08)D;B组术后1d、1个月、3个月术源性散光均明显小于A组,差异均有显著统计学意义(均为P<0.01)。B组术后3个月BCVA及术后3d、1个月、3个月角膜内皮细胞计数均高于A组,差异均有统计学意义(均为P<0.05)。结论超声乳化人工晶状体植入术采用改良巩膜隧道切口较透明角膜切口更有利于患者术后视功能的恢复,能减少术源性散光,且并发症少。

Objective To analyze and compare the clinical effects of phacoemulsification with different incision on high myopia-combined cataract. Methods Clinical information of 51 patients（ 65 eyes） with high myopia-combined cataract that had received phacoemulsification were divided into two groups by their choices of incision type：group A（ clear corneal incision group） and group B（ improved scleral tunnel incision group）. Follow-ups lasted for from 3 months to 6 months postoperatively. Information about central corneal thickness （CCT）, surgically induced astigmatism and corneal endothelial cell（CEC） number of the two groups was collected and analyzed at 4 pointsin time,preoperatively and 3 days, 1 month, and 3 months after the operation. BVCA of the two groups was observed at the 3rd month postoperatively. Complications of two groups were also observed in the mean time. Results Compared with preoperative CCT,postoperative CCT of the two groups at the postoperative points-in time were significantly higher（ all P 〈 0.05 ） ;At the 3rd day postoperatively, CCT of group B was lower than that of group A（P 〈0.05 ） ;Differences of CCT between the two groups 1 month and 3 months after the operation were both of no statistical significance （ both P 〈 0. 05 ）. Surgically induced astigmatism （degree） of group A at all the 3 postoperative points-in time （0.64 ± 0.25,0.51 ± 0.26,0.48 ± 0.18 ） were significantly higher than that of group B （0.35 ± 0.14,0.28 ± 0.12,0.27 ± 0.08 ） （all P 〈 0.01 ） ;BCVA of group B at the 3rd month postoperatively was higher than that of group A（P 〈 0.05 ）. CEC number of group B at all the 3 postoperative points-in time were larger than that of group A （ all P 〈 0.05）. Conelusion Phacoemulsification with improved scleral tunnel incision can restore visual acuity of the patients better with lower surgically induced astigmatism and less complications.