微小切口超声乳化术治疗短眼轴白内障的临床观察

Clinical research of micro- incision phacoemulsification for short axis cataract

目的：观察2.2mm透明角膜切口晶状体超声乳化联合超薄人工晶状体植入术治疗短眼轴白内障的临床疗效和安全性,并与传统的3.0mm透明角膜切口超声乳化手术进行比较。方法：前瞻性随机对照研究。将60例60眼眼轴为17.68-21.32（平均20.35±0.61）mm的年龄相关性白内障患者随机分为两组,分别行2.2mm同轴微小切口白内障超声乳化吸出术（微小切口组,植入Akreos MI60 IOL）和3.0mm同轴小切口白内障超声乳化吸出术（小切口组,植入Akreos Adapt IOL）,平均眼轴分别为：20.57±0.39,20.21±0.52mm。分别记录两组患者超声乳化所用的有效超声时间（EPT）和平均超声能量（AVE）。术后随访1,7,30,90d,观察术后最佳矫正视力、眼压、中央前房深度、角膜内皮细胞密度、手术源性散光和手术并发症。结果：两组所用EPT和AVE差异无统计学意义（P〉0.05）。术后1,7,30d微小切口组的手术源性散光低于小切口组,两组间差异均具有统计学意义（P〈0.05）,而术后90d的两组间差异没有统计学意义（P〉0.05）。两组间最佳矫正视力在7d两组相比有统计学意义（P〈0.05）,但在术后30d和90d两组相比差异无统计学意义（P〉0.05）。两组患者术后7,30,90d角膜内皮细胞密度微小切口组均高于小切口组,两组之间比较差异无统计学意义（P〉0.05）。两组患者术后前房深度较术前明显加深,组间比较无显著性差异。所有患者术中前房稳定,术中及术后均无并发症发生,无切口热烧伤。结论：2.2mm同轴微切口于传统的同轴3.0mm小切口超声乳化手术白内障手术相比,术中具有同样的安全性,且2.2mm同轴微切口手术手术源性散光小、组织损伤小、可显著改善患者的早期视功能。

AIM ： To observe the clinical effect of 2. 2mm micro-incision phacoem ulsification（ Phaco） combined intraocular lens（ IOL） implantation in the eyes with short axial length and compared with traditional 3. 0mm incision phacoem ulsification operation for clinical work and research objective information.METHODS： In this prospective clinical control study,60cases（ 60 eyes） with cataract perform ed 2. 2mm micro-incision phacoem ulsification combined IOL implantation（ micro-incision group,implanted Akreos MI60 IOL） and3. 0mm incision phacoem ulsification operation（ sm all incision group, implanted Akreos Adapt IOL）, whose axial length ranged 17. 68 - 21. 32 mm,average 20. 35 ±0. 61 mm. Average axiall ength respectively of two groups： 20. 57±0. 39 m m and 20. 21±0. 52 m m. Effect Phaco tim e（ EPT） and average ultrasonic energy（ AVE） were recorded. The best corrected visual acuity（ BCVA）,intraocular pressure（ IOP）, anterior cham ber depth（ ACD）,corneal endothelial cell density and the operative complications were observed postoperatively. All cases were followed up at 1,7,30 and 90 d after operation.RESULTS： EPT and AVE between two groups had no statistical significance（ P〉0. 05）. At the 1,7 and 30 d after surgery,induced astigm atism（ SIA） of micro- incisiongroup was lower than that of small-incision group. SIA betw een two groups had statistically significant（ P〉0.05）,but in the 90 d SIA between two groups had no statistical significance（ P〉0. 05）. At the 7d,the BCVA between two groups had statistical significance（ P〉0. 05）,but at the 30 and 90 d,BCVA between two groups had no statistical significance（ P〉0. 05）. At the 7,30 and 90 d,corneal endothelial cell density of micro- incision group was higher than that of small incision group. Corneal endothelial cell density between two groups had no statistical significance. The m ean ACD was significant increased postoperatively than preoperatively and had no statistical significance（ P〉0. 05）. The anterior chamber stabilized during the operation. There was not incision hot harm ed during operation and postoperation.CONCLUSION： Compared with 2. 2mm micro-incision and traditional 3. 0mm incision phacoem ulsification,two groups have the same safety and 2. 2m m micro-incision phacoem ulsification has small SIA, organization small harm and improved visual acuity in early stage.