不同大小透明角膜切口超声乳化术后早期稳定性的对比研究

Early stability of clear corneal incision in morphology after cataract phacoemulsification

目的通过眼前段光学相干断层扫描仪(anterior segment optical coherence tomography,OCT),观察分别经2.2 mm、3.0 mm透明角膜切口白内障超声乳化吸除手术后24 h的切口形态,探讨切口的稳定性。方法选择年龄相关性白内障患者120例(120眼)进行超声乳化白内障吸除术,晶状体核硬度<Ⅳ级82例(82眼),≥Ⅳ级38例(38眼),随机选择2.2 mm、3.0 mm透明角膜手术切口。术后24 h应用眼前段OCT对切口处角膜进行观察,用非接触眼压仪测量眼压。结果术前晶状体核硬度<Ⅳ级术眼眼压为(15.21±1.38)mmHg(1 kPa=7.5 mmHg),术后24 h眼压为(15.45±1.43)mmHg,术前、术后眼压差异无统计学意义(t=-0.32,P>0.05);核硬度≥Ⅳ级术眼眼压为(16.00±2.01)mmHg,术后24 h眼压为(16.21±1.75)mmHg,术前、术后眼压差异无统计学意义(t=-0.51,P>0.05)。眼前段OCT观察显示,在晶状体核硬度<Ⅳ级的患者术眼中,2.2 mm及3.0 mm两种透明角膜切口术后24 h切口处的外切口哆开、内切口哆开及后弹力层脱离等切口并发症的发生率差异均无统计学意义(均为P>0.05);在晶状体核硬度≥Ⅳ级的患者术眼中,2.2 mm组术后24 h切口处的外切口哆开、内切口哆开及后弹力层脱离等切口并发症的发生率均高于3.0 mm组(均为P<0.05)。结论晶状体核硬度≥Ⅳ级的白内障患者,3.0 mm透明角膜切口白内障超声乳化手术后24 h切口的愈合程度高于.2

Objective To observe the morphology of corneal incisions at 24 hours after phacoemulsification operation through the 2. 2 mm and 3. 0 mm clear corneal incision respectively by anterior segment optical coherence tomography（ OCT）,and investigate the stability of corneal incision. Methods A total of 120 patients（ 120 eyes） with aged-related cataract were selected to perform phacoemulsification randomly. The lens nucleus hardness in 82 eyes were less than IV class,and 38 eyes equal to or more than IV class. The patients were selected randomly to use 2. 2 mm or 3. 0 mm transparent corneal incision. The corneal incision was observed at 24 hours after the operation by OCT,and the intraocular pressure was measured with non-contact intraocular pressure meter. Results The preoperative intraocular pressure in 82 eyes with nucleus hardness less than IV class was（ 15. 21 ± 1. 38） mmHg（ 1 kPa = 7. 5 mmHg）,the postoperative24 hours was（ 15. 45 ± 1. 43） mmHg,there was no statistical difference（ t =- 0. 32,P〉0.05）. The preoperative intraocular pressure in 38 eyes with nucleus hardness equal to or more than IV class was（ 16. 00 ± 2. 01） mmHg,the postoperative 24 hours was（ 16. 21 ± 1. 75） mmHg,there was no statistical difference（ t =- 0. 51,P〉0. 05）. For〈IV class cataract,there was no statistical difference in the incidences of inner cut or outside corneal incision dehiscence,Desecemet membrane detachment between two different sizes corneal incisions（ all P〉0. 05）.But for ≥IV class nuclei cataract,morphologic variations above in 2. 2 mm group was higher than those in 3. 0 mm group（ all P〈0. 05）. Conclusion The stability of transparent corneal incision of 3. 0 mm in short times after phacoemulsification operation is better than it of 2. 0 mm for ≥IV class nuclei cataract.