超小切口手法碎核白内障摘出术的临床观察

Clinical observation of super-small incision extraction of cataract with manual nucleus fragmentation

目的：探讨2.8 mm带球结膜的角膜缘隧道式超小切口的白内障手法碎核摘出术的手术技术和临床效果。方法前瞻性病例研究,105例（120眼）随机分为两组：手法碎核组：52例（60眼）Ⅰ-Ⅲ级核老年性白内障行2.8 mm带0.5-1.0 mm球结膜的角膜缘隧道式切口的晶状体手法碎核摘出术,采用以宽1.5 mm的虹膜恢复器作支撑和滑板,以劈核器进行劈核、分核、挖核、捣核,搅核等方法。超声乳化组：53例（60眼）Ⅰ-Ⅲ级核老年性白内障行2.8 mm透明角膜隧道式切口的常规超声乳化吸出术,采用劈核技术。观察比较两组术中、术后并发症、术后视力、角膜内皮细胞平均丢失率及平均角膜散光度等变化。结果两组术中均无后囊破裂或悬韧带损伤等并发症发生。手法碎核组术后6 h视力0.1-0.4者55眼占91.7%,0.5-0.8者5眼占8.3%。两组术后1 d,术后1周及术后3个月的视力、术后角膜创口处水肿发生率、术后1个月角膜内皮细胞平均丢失率、术后1个月平均散光度变化值,两组数据比较差异均无统计学意义（P〉0.05）。结论对晶状体核硬度Ⅰ-Ⅲ级的白内障行2.8 mm带球结膜的角膜缘隧道式切口的手法碎核摘出术可控性好,手术安全简便,效果与切口同样大小的超声乳化术相当,但可更早恢复视力,更早术后观察处理。为手法小切口白内障手术提供了一种新的更为安全有效俭省的手术方法。

Objective To evaluate the clinical efficacy of 2. 8 mm incision cataract extraction with manual nucleus fragmentation. Methods A prospective study. One hundred and twenty eyes of 105 patients with nuclear hardness of grade Ⅰ to grade Ⅲ were randomly divided into two groups. In group A （manual nucleus fragmentation group）,60 eyes of 52 patients with age-related cataract were enrolled. 2. 8 mm corneal tunnel incision with 0. 5-1. 0 mm bulbar conjunctival flap were done, and then manual nucleus fragmentation cataract extraction which consisted of splitting, smashing and disturbing of the nucleus was performed. In group B（phacoemulsification group）, 2. 8 mm corneal tunnel incision with phacoemulsification using Chopper-phaco technique was performed on 60 eyes of 53 patients with age-related cataracts. The complications, vision, average losing ratio of corneal endothelial cells and corneal astigmatism were observed. Results No capsular rupture, zonular injury or other complications occurred during operation in the two groups. In manual nucleus fragmentation group, the vision ranged from 0. 1 to 0. 4 in 55 eyes （91. 7%）, from 0. 5 to 0. 8 in 5 eyes（8. 3%） 6 hours after operation. The difference in vision examined 1 d, 7 d and 3 months after operation were not statistically significant between the two groups. The differences in cornea edema, average losing rate of corneal endothelial cells, and astigmatism were not statistically different from each other between the two groups（P〉0. 05）. Conclusion Cataract extraction with manual nucleus fragmentation by 2. 8 mm bulbar conjunctival flap corneal tunnel incision is effective, safe and easy-handling for cataract patients with the nucleus hardness of grade Ⅰ-Ⅲ.