透明角膜切口与巩膜隧道切口超声乳化白内障手术后角膜改变的临床观察

Clinical observation of the corneal changes after clear corneal incision and the phacoemulsification of scleral tunnel incision

目的:探讨透明角膜切口和巩膜隧道切口超声乳化白内障手术对角膜的影响。方法:选择在我院住院的325例(384眼)老年性白内障患者,随机分成两组,A组200例(238眼),B组125例(146眼),A组行透明角膜切口白内障超声乳化摘除联合人工晶体植入术,B组行巩膜隧道切口白内障超声乳化摘除联合人工晶体植入术。通过分析比较两种不同切口超声乳化白内障手术后不同时间点泪膜功能、角膜散光、角膜厚度、角膜内皮等方面的变化情况,从而探讨这两种切口超声乳化白内障手术对角膜的影响。结果:①两组患者术后早期泪膜功能均降低,部分患者有较明显的干眼症状,术后3d、1周、2周泪膜破裂时间(BUT)均较术前明显缩短(P<0.05),且两组组间比较差异有统计学意义(P<0.05),术后1个月、3个月两组BUT与术前比较和组间比较均无统计学意义(P>0.05)。②两组患者术后3d、1周、2周、1个月和3个月术眼散光度数均较术前增加,其中术后3d、1周、2周、1个月与术前比较差异有统计学意义(P<0.05),同时对A、B两组进行组间比较发现A组患者的散光度较B组大,差异显著(P<0.05)。术后3个月与术前相比及两组进行组间比较,差异无统计学意义(P>0.05)。③两组患者术后3d、1周和2周术眼中央区和切口附近角膜厚度较术前均增加,且A组切口附近角膜厚度较B组厚,差异有统计学意义(P<0.05);1个月和3个月术眼中央区和切口附近角膜厚度较术前及A、B两组间差异均不明显(P>0.05)。④两组患者术后3d、1周和2周术眼角膜内皮细胞密度和六边形细胞百分率较术前有较明显的下降,差异有统计学意义(P<0.05),且A、B两组组间比较差异有统计学意义(P<0.05);随着时间的推移,角膜内皮细胞的密度和六边形细胞百分率逐渐增加,到术后1个月时基本上升到正常水平。两组进行组间比较发现B组较A组下降程度更大,恢复的速度稍慢。结论:透明角膜切口超声乳化白内障手术与巩膜隧道切口超声乳化白内障手术相比,具有对泪膜功能、角膜散光、角膜厚度、角膜内皮影响小和术后恢复快等优点,是一种更值得推广的超声乳化白内障手术切口方式。

Objectives： To investigate the effect of phacoemulsification of clear corneal incision and phacoemulsification of scleral tunnel incision of cataract on the cornea after operation. Methods： 325 patients （384 eyes） admitted into our hospital with age-related cataract from October of 2009 to December of 2011 were randomized into the two groups： Group A （200 patients, 238 eyes） were performed clear corneal incision combined with phacoemulsification of scleral tunnel incision of cata- ract, while group B （125 patients, 146 eyes） were with scleral tunnel incision combined with phaco- emulsification. The function of tear film, corneal astigmatism, corneal tickness and corneal endo- thelial changes by different incisions at different time points after operation of both groups were compared with so as to discuss the effect of two different surgeries on the cornea of patients. Re- sults： （1） The functions of early tear film of patients in both groups decreased, some patients have obviously symptoms of dry eyes. The breakup time of tear film （BUT） was sharply reduced 3 days, 1 week, and 2 weeks after operations （P〈0.05）, and there was significantly difference between the two groups （P〈0.05）. However, there was no differences for BUT between the two groups com- pared 1 month and 3 months postoperations with pre-operations （P〉0.05） ; （2） The astigmatism degree of the operated eyes increased in both groups 3 days, 1 week, 2 weeks, 1 month, and 3 months after surgeries, which was statistically differente compared with those before operation （P 〈0.05）. Meanwhile, the research found that the astigmatism degree of Group A was larger than that of Group B, which was of statistical difference （P〈0.05）. But compared the astigmatism de- gree of patients 3 months after operations with that of patients before operations in both groups, there were no statistical difference （P〈0.05） ; （3） The thickness of the central cornea and the cor- nea near the incision 3 days, 1 week and 2 weeks after operations increased more than that of the patients before operations, and the central cornea and the cornea near the incision of Group A was thicker than that of Group B, which was significantly different （P（0.05）. But there was no signif- icantly difference 1 month and 3 months after surgery and before operations between; （4） The den- sity of corneal endothelial cells and the percentage of hexagonal cells of both groups were signifi- cantly decreased 3 days, 1 week and 2 weeks after surgery, which were of statistical difference （P〈 0.05）, and there were also significantly different between the two groups （P〈0.05）. With the passage of time, the density of corneal endothelial cells and the percentage of hexagonal cells rose gradually, and almost reached to the normal levels 1 month after surgeries. The omparision of group A with Group B indicated that the density of corneal endothelial cells and the percentage of hexagonal cells of patients in Group B decreased more than Group A, so patients in Group B recov- ered much slower than group A. Conclusion： Compared with phacoemulsification of scleral tunnel incision of cataract on the cornea, phacoemulsification of clear corneal incision has much more ad- vantages, it has much less effect on the function of tear film, corneal astigmatism, corneal tickness and corneal endothelial, also, it has faster postoperative recovery. So the phacoemulsification of clear corneal incision is worth promoting.