超声乳化与非超声乳化白内障摘除术的临床对照研究

Clinical comparison of phacoemulsification and non-phacoemulsification for cataract

目的:对比分析小切口超声乳化和非超声乳化白内障摘除术的临床效果。方法:选取白内障患者172例,以随机数字法分为两组(n=86);Phaco组采用小切口超声乳化白内障吸除和人工晶状体植入术,Siecs组采用小切口非超声乳化白内障摘除和人工晶状体植入术;并分别于术后3d;1,6mo和末次随访进行功能测定,对比组间视力、眼内压、前房深度、平均角膜曲率(average corneal power,ACP)、角膜表面散光值(cylinder,CYL)和角膜表面不对称指数(surface asymmetry index,SAI)及手术并发症。结果:术后3d,Phaco组视力情况显著优于Siecs组(P<0.05),CYL、SAI和眼内压显著低于Siecs组(P<0.05);术后1mo,Phaco组视力情况显著优于Siecs组(P<0.05),CYL,SAI和眼内压稍低于Siecs组,但无组间差异(P>0.05);术后6mo,Phaco组视力情况依然稍优于Siecs组,但无组间差异(P>0.05),CYL,SAI和眼内压与Siecs组持平(P>0.05);此外,两组患者的ACP与前房深度各时间点测定值无组间差异(P>0.05)。在术后并发症方面,两组患者的总发生率相仿(P>0.05);但有个体差异,Phaco组Ⅱ,Ⅲ级核患者的发生率显著低于Siecs组(P<0.05),Ⅳ级核患者的发生率显著高于Siecs组(P<0.05)。结论:超声乳化白内障摘除术治疗Ⅱ,Ⅲ级核白内障患者可获得更好的疗效,但对于Ⅳ级核病变患者并发症风险较高,可考虑小切口非超声乳化白内障摘除术。

AIM： To contrast the effect of small incision phacoemulsification and non-phacoemulsification to treat cataract. METHODS： Totally 172 patients with cataract were divided into 2 groups（n=86）randomly. Patients in Group Phaco were treated with phacoemulsification and, while those in Group Siecs were treated with small incision extracapsular cataract surgery and intraocular lens implantation. They were all followed up for 1-3y. Functional examinations were made at 3d; 1,6mo and last follow-up. The visual acuity, intraocular pressure, anterior chamber depth, average corneal power（ACP）, cylinder（CYL）, surface asymmetry index（SAI）and complications were contrasted between groups. RESULTS： At 3d after operation, the visual acuity of Group Phaco was better than that of Group Siecs（P〈0.05）, and CYL, SAI and intraocular pressure of Group Phaco were all significantly lower than those of Group Siecs（P〈0.05）. At 1mo after operation, the visual acuity of Group Phaco was better than that of Group Siecs（P〈0.05）, and CYL, SAI and intraocular pressure of Group Phaco were slightly lower than those of Group Siecs（P〈0.05）; there was no difference between the two group. At 6mo after operation, the visual acuity of Group Phaco was still better than that of Group Siecs（P〈0.05）, and CYL, SAI and intraocular pressure of Group Phaco were flat as those of Group Siecs（P〈0.05）; there was no difference between groups in those indexes above（P〉0.05）. Furthermore, the APC and anterior chamber depth of each point-in-time had no significant difference between groups（P〉0.05）. The incidences of complication were similar in two groups（P〉0.05）; but with individual differences, patients of GradeⅡ and Ⅲ in Group Phaco got lower complication rate（P〈0.05）, while those of Grade Ⅳ higher（P〈0.05）than those of Group Siecs. CONCLUSION： Our research shows that phacoemulsification has high effect in the treatment of patients with GradeⅡ and Ⅲ nuclear hardness, while small incision extracapsular cataract surgery has high effect in the treatment of patients with Grade Ⅳ nuclear hardness.