白内障手术中反向超声乳化对角膜内皮的保护作用

Protective effect of reverse phacoemulsification on corneal endothelium in cataract surgery

目的:研究反向超声乳化针头斜面朝向后方(反向超声乳化)对角膜内皮的保护作用。方法:对60例60眼老年性白内障患者,随机分成两组,常规超声组和反向超声组,术前常规进行全身及眼科专科检查,并详细记录每位患者的性别、年龄、核硬度分级、角膜内皮计数、眼压、前房深度、轴深等数据;两组患者分别采用常规超声乳化和反向超声乳化的方式完成超声乳化和折叠式人工晶状体的植入,记录术中超声乳化时所使用的平均超声能量和有效超声时间,最终可计算出平均复合超声能量(平均超声能量×有效超声时间),同时记录术中出现的手术并发症等情况;术后第3d对两组患者进行眼压和角膜内皮细胞计数检查。结果:经统计,术前两组患者基本情况无明显统计学差异(P>0.05)。两组患者分别经不同的超声乳化方式治疗后,两组患者在手术中所接受的平均复合超声能量和术后第3d的眼压无明显统计学差异(t=-0.95,P=0.924>0.05;t=0.34,P=0.735>0.05)。而两组患者术后第3d的角膜内皮细胞丢失数量比较,有明显统计学差异(t=-9.89,P<0.01)。结论:反向超声乳化较常规方式超声乳化有明显的保护角膜内皮细胞、减少损伤的作用,值得临床工作中推广。

AIM; To research the protective effect of reverse phacoemulsification on corneal endothelium in cataract surgery. METHODS： Sixty patients （60 eyes） with senile cataract were randomly divided into two groups, the conventional phacoemulsification group and the reverse phacoemulsification group. The preoperative general and special ophthalmic examinations were routinely conducted. The gender, age, grade of nuclear hardness, corneal endothelial counts, intraocular pressure, anterior chamber depth, and axis shaft of each patient were carefully recorded. The phacoemulsification and the foldable intraocular lens implantation of two groups were individually accomplished through conventional phacoemulsification and reverse phacoemulsification. The average ultrasonic energy and the valid ultrasound time of phacoemulsification during operation were recorded, the average compound ultrasonic energy （average ultrasonic energy x valid ultrasound time） was finally calculated, and surgical complications during operation were recorded at the same time. The corneal endothelial counts and intraocular pressure of two groups were inspected at postoperative 3d. RESULTS. According to statistics, there was no significant difference for patients with basic situation between two groups （P〉 0. 05）. After treatment with different phacoemulsification methods, the intraocular pressure at postoperative 3d and the accepted average compound ultrasonic energy of patients were showed no significant differences （ t= -0.95, P= 0. 924〉0. 05; t= 0.34, P= 0.735〉0.05）. However, there was significant difference for loss number of corneal endothelial at postoperative 3d （t=-9.89, P〈0.01）. CONCLUSION： The protective effect of reverse phacoemulsification on corneal endothelial and decreasing damages is better than that of the conventional phacoemulsification, and it is worth of popularization in clinical practice.