360例老年性白内障采用超声乳化白内障吸除联合人工晶状体植入术治疗的临床疗效观察

Application of different processing methods of lens nucleus in phacoemulsification

目的探讨老年性白内障采用超声乳化白内障吸除联合人工晶状体植入术治疗的临床疗效。方法收集北京市房山区良乡医院眼科2012年10月至2014年2月接受超声乳化白内障吸除联合人工晶状体植入术的360例（360只眼）白内障患者的临床资料。根据晶状体核的硬度将患者分为3组：Ⅰ~Ⅱ级核组（A组）111例（111只眼）、Ⅲ级核组（B组）168例（168只眼）及Ⅳ~Ⅴ级核组（C组）81例（81只眼）。所有患者均行超声乳化白内障吸除联合人工晶状体植入术,术后1 d、1周及1个月对患者进行视力检查,患者的视力按照〈0.05,0.05~0.3,0.4~0.5,0.6~0.8及1.0分为5个等级。术后患者的视力情况采用百分比的形式进行描述,并采用Kruskal-Wallis H秩和检验的方法进行比较;采用χ2检验的方法比较3组患者术中及术后并发症的发生情况。结果术后1 d,视力〈0.05者19例（19只眼）,占5.28%;视力0.05~0.3者59例（59只眼）,占16.39%;视力0.4~0.5者82例（82只眼）,占22.78%;视力0.6~0.8者102例（102只眼）,占28.33%;视力1.0者98例（98只眼）,占27.22%。术后1周,视力〈0.05者11例（11只眼）,占3.06%;视力0.05~0.3者32例（32只眼）,占8.89%;视力0.4~0.5者57例（57只眼）,占15.83%;视力0.6~0.8者154例（154只眼）,占42.78%;视力1.0者106例（106只眼）,占29.44%。术后1个月,视力〈0.05者3例（3只眼）,占5.28%;视力0.05~0.3者12例（12只眼）,占16.39%;视力0.4~0.5者70例（70只眼）,占19.44%;视力0.6~0.8者166例（166只眼）,占46.11%;视力1.0者108例（108只眼）,占30.00;术后患者视力情况比较,差异无统计学意义（Hc=0.79,P〉0.05）。A组患者术后无并发症发生。B组术后发生并发症的患者共12例（12只眼）,占7.14%,其中术后发生角膜水肿9例（9只眼）,占5.35%;发生虹膜炎症反应3例（3只眼）,占1.78%。C组术后发生并发症的患者共27例（27只眼）,占33.33%,其中术中发生后囊破裂3例（3只眼）,占3.70%;术后发生角膜水肿15例（15只眼）,占18.51%;发生虹膜炎症反应8例（8只眼）,占9.88%;发生暂时性高眼压1例（1只眼）,占1.23%;3组患者术中及术后并发症的发生情况比较,差异有统计学意义（χ2=29.29,P〈0.05）。结论超声乳化白内障吸除联合人工晶状体植入术治疗治疗老年性白内障,手术方式是可行的,术中对不同硬度的晶状体核采取不同的处理方法能高效的完成手术。但随着晶状体核硬度的增加其术中术后并发症的发生也相应增加,值得进一步扩大病例数,深入研究。

Objective To investigate the application of different processing methods of lens nucleus in phacoemulsifieation. Methods A total of 360 patients （360 eyes ） with age-related cataract who were seeking care in Department of Ophthalmology, Liangxiang Hospital, Fangshan District, Beijing were consecutively recruited between October, 2012 and January,2014. Based on the hardness of the eataraetous lens nucleus,patients were classified as ： I-II lens nucleus （ n = 111 ） , Ⅲ lens nucleus （ n = 168 ） and IV-V lens nucleus （n= 81 ）. All patients underwent phaeoemulsification and intraocular lens （IOL） implantation. Data on postoperative visual acuity and postoperative complications were collected at different time points and analyzed. Results Phacoemulsifieation and IOL implantation resulted in vision improvement in a time- dependent manner;at one week after operation,visual acuity was ≤0.3 in 43 （ 11.94% ） eyes,0.4-0.5 in 57 （ 15.83% ） eyes,0. 6-0.8 in 154 （42.78%） eyes and ≥ 1.0 in 106 （29.44%） eyes,but at one month,the percentage of patients with visual acuity ≤0.3 was reduced to 4.16% while the percentage of patients with visual acuity of 0. 4-0.5,0.6-0.8 and ≥ 1.0 was increased to 19.44% , 46. 11% and 30.00% respectively. Inter and postoperation complications were observed in none of the I-II lens nucleus cases but in 12 （7. 14%） Ⅲ lens nucleus cases and in 27 （33. 33%） IV-V lens nucleus cases （P〈O. 05）. Conclusion Phacoemulsification combined with IOL implantation may offer an effective and safe treatment of age-related cataract ,hut the outcome is negatively associated with the hardness of lens nucleus.