不同灌注套管与超声乳化针头配套对白内障超声乳化切口的影响

Different perfusion cannula and needle supporting for phacoemulsification effect of phacoemulsification incision

目的：探讨通过改变灌注套管与超声乳化针头的配套,缩小白内障超声乳化手术切口,减少术源性散光。方法：选取年龄相关性白内障患者98例（120眼）,年龄52~80岁,晶状体混浊2-3级,按随机数字表法分为2组,A组46例（60眼）,B组52例（60眼）。A组将（美国Bausch＆Lomb公司）Stellaris超声乳化仪的3.2mm超声乳化针头更换为1.8mm的针头,但仍用原3.2mm灌注套管,将手术切口减小到2.2 mm行同轴微切口白内障超声乳化联合人工晶状体植入术,B组行3.2 mm传统同轴超声乳化联合人工晶状体植入术。术中记录超声乳化时间和能量,术后第1天、第1周和第1个月观察随访,记录术后的裸眼视力、散光改变、超声凡是能够影响角膜曲率的原因都能引起白内障术后的角膜散光。因手术切口造成的角膜术源性散光,是影响白内障患者术后视觉质量的主要因素。透明角膜的切口越小,角膜的术源性散光也就越小。1资料和方法乳化时间及能量,并对所得数据进行分析。结果：术前与术后相比,角膜散光均有不同程度改变;术后第1天、第1周和第1个月,A组角膜散光均小于B组,差异有统计学意义（P〈0.05）。视力变化：术后第1周,A组裸眼视力好于B组,两组之间存在统计学差异（P〈0.05）,术后第1天和第1个月视力无统计学差异（P〉0.05）。平均超声乳化时间、有效超声乳化时间、平均超声乳化能量均无统计学差异（P〉0.05）。结论：通过改变灌注套管与超声乳化针头的配套即可将传统3.2mm手术切口缩小至2.2 mm,既满足人工晶体植入的要求,又有效减少术源性散光,早期视力恢复快,前房密闭稳定,手术安全可靠。

Objective：To observe the clinical outcome of phacoemulsification through 1.8 mm coaxial microincision and compare it with that of phacoemulsification through 3.2 mm coaxial incision. Methods： Sixty eyes of 46 patients with age-related cataract （grade Ⅲ lens opacity） at the age of 52 to 80 years were randomly divided into group A （n=60） and group B （n=60）. Eyes in group A underwent phacoemulsification through 1.8 mm coaxial microincision and artificial lens implantation while those in group B underwent phacoemulsification through 3.2 mm coaxial incision and artificial lens implantation. Phaco power and time were recorded during operation. The patients were followed up in 1 day,1 week and 1 month after operation,during which corneal astigmatism,visual acuity of naked eyes, corneal endothelial cell count and complications were recorded. Results：No significant difference was found in the average phaco time（APT） ,effective phaco time（EPT） and average phaco power（AVE） between the two groups during operation（P〉0.05） . The visual acuity of naked eyes was better in group A than in group B in the first week after operation（P〈0.05） with no significant difference between the two groups on 1 day and in the first month after operation （P〉0.05） . The surgical astigmatism in group A was less than that of group B in every time point （P〈0.05）.No statistically significant difference was found in the corneal endothelial cell count between the two groups in every time position after operation （P〉0.05）. Conclusion：Phacoemulsification through 1.8 mm coaxial microincision can reduce thecorneal astigmatism,rapidly restore the early.