预劈核在白内障超声乳化吸除术中的效果观察

Clinical observation of the application of pre-chop in phacoemulsification

目的：探讨预劈核在超声乳化白内障吸除术的应用及效果。方法将晶状体核硬度为III-IV级的单纯白内障患者519例（634只眼）随机分为预劈核组和非预劈核组。预劈核组（341只眼）：不进行水分离、水分层，用劈核钩及截囊针将核分成四分后直接行超声乳化；非预劈核组（293只眼）：传统方法水分离、水分层后，采用乳化劈核后行超声乳化。术中设定负压300 mmHg（1 mmHg ＝0．133 kPa）；最大能量均为40％。记录术中使用的实际超声能量和时间、术前和术后1周的视力及角膜内皮细胞计数，观察术中术后手术并发症的发生情况。结果预劈核组及非预劈核组实际使用的超声能量分别为（16．36±6．65）％、（30．54±3．50）％；超声时间分别为（26±6） s、（93±41） s ；两组患者所用的实际超声能量和时间比较，均有显著差异（ P ＜0．05）。两组患者术后视力比较，无显著差异（ P ＝1．062）。两组患者角膜内皮细胞丢失率和角膜水肿程度比较，有显著差异（ P ＜0．05）。结论预劈核超声乳化白内障吸除术操作简便，超声时间短，眼内组织损伤小。

Objective To evaluate the clinical effects of pre-chop before phacoemulsification.Methods In this study, 519 simple cataract patients （634 eyes） with III-IV nucleus hardness were randomly divided into two groups：pre-chop group, 341 eyes, and no-pre-chop group, 293 eyes.For patients in pre-chop group, instead of hydro-dissection, pa-tients received phacoemulsification after pre-chop by using chop and needle.In no-pre-chop group, patients received tradi-tional hydro-dissection and phacoemulsification.In each group, vacuum pressure was 300 mm Hg and the power was set to 40%.Actual phaco power, phaco time, visual acuity, corneal edema, endothelial cell loss, and other complications were recorded and compared between the two groups.Results The actual phaco power used were 16.36%±6.65% in pre-chop group and 30.54%±3.50% in no-pre-chop group, respectively.Phaco time was 26 ±6 sec versus 93 ±41 sec. These differences were significant （ P 〈0.05）.Visual acuity significantly improved in all patients, and there was no difference between the two groups of patients.Endothelial cell loss and corneal edema were significant lower in the pre-chop group than in the no-pre-chop group.Conclusion The use of pre-chop before phacoemulsification reduced actual phaco power, phaco time, and loss of corneal endothelial cell, and chances of corneal edema.