不同切口白内障超声乳化吸除术对白内障患者角膜屈光状态及视觉质量的影响

The Effect of Different Phacoemulsification Incisions on Corneal Refractive Status and Visual Quality of Patients with Cataract

目的探究不同切口白内障超声乳化吸除术对白内障患者角膜屈光状态及视觉质量的影响。方法选取2014年1—12月洪泽县人民医院眼科收住入院的白内障患者120侧120眼。按随机数字表法随机分为A、B两组，各60眼。A组于12：oo钟位做3mm巩膜隧道切口，B组于12：00钟位做3mm透明角膜切口，均经切口行超声乳化吸除术及人工晶状体植入术。比较两组治疗前及治疗后1、4、8周散光度、角膜表面不对称指数（SAI）、角膜敏感度、最佳矫正视力（BCVA）和黄斑中心凹处视网膜厚度（CMT）变化情况。结果治疗前两组在散光度、SAI、角膜灵敏度、BCVA、CMT等方面差异无统计学意义（P〉0．05）。术后1、4、8周，A组散光度分别为（1．12±0．23）DC、（0．78±0．18）DC、（0．44±0．12）DC，B组分别为（1．29±0．30）DC、（0．97±O．21）DC、（0．60±0．23）DC，较术前有所降低；A组BCVA分别为0．44±0．06、0．78±0．08、0．77±0．08，B组分别为0．34±0．04、0．65±0．07、0．66±0．07，较术前有所提高。差异有统计学意义（P〈0．05）；两组角膜灵敏度、CMT治疗前后差异无统计学意义（P〉0．05），治疗后A组和B组的SAI均分别为0．14±0．04、0．34±O．08，高于治疗前的0．12±0．02和0．13±0．03，且治疗后A组SAI明显低于B组（P〈0．05）。结论两种手术切口条件下行白内障超声乳化吸除术均可显著改善术后患者的视觉质量，但巩膜隧道切口对角膜内皮损伤更小，术后同期患者角膜散光度数、BCVA优于透明角膜切口组，具有更高的临床应用价值。

Objective To explore the effect of different phacoemulsification incisions on corneal refrac- tive status and visual quality of patients with cataract. Methods A total of 120 patients（ 120 eyes） with cat- aract in Hongze People＇s Hospital were chosen from January to December 2014. They were randomly divided into group A and group B ,60 eyes in each group. Incision was made 3 mm scleral tunnel at 12：00 clock bit in group A,while was made 3 mm clear corneal incision at 12：00 clock place in group B,and surgery of phaeoemulsification cataract and absorbing intraocular lens implantation were clone through the different inci- sions. The differences of astigmatism, corneal asymmetry index （SAI） , corneal sensitivity, best corrected visual acuity （BCVA） and central macular retinal thickness （CMT） recess after treatment changes before treatment and one week,four weeks,eight weeks after the therapy of the two groups were compared. Results Before the treatment, there was no statistically significant difference in astigmatism, SAI, corneal sensitivity, BCVA, CMT（ P 〉 0. 05 ）. After one week ,four weeks, eight weeks, astigmatism of group A was （1.12 ± 0. 23 ） DC, （0.78±0. 18） DC,（0.44±0. 12） DC,of group B was （1.29 ±0.30） DC,（0.97 ±0.21） DC,（0.60 ± 0. 23） DC; after one week, four weeks, eight weeks, BCVA of group A was 0. 44 ± 0.06,0. 78 ±0. 08, 0.77 ±0. 08, of group B was 0. 34 ± 0. 04,0. 65 ± 0. 07,0.66 ± O. 07, the differences were statistically signif- icant （ P 〈 0.05 ） ; the corneal sensitivity, CMT of the two groups before and after treatment showed no sigrfifi- cant difference （ P 〉 0. 05 ）, after treatment SAI in group A and group B were 0. 14± 0.04,0.34 ± 0. 08 respectively,higher than 0. 12 ± 0. 02 and 0. 13 ± 0. 03 before treatment,and after treatment group A were significantly lower than group B （P 〈 0. 05 ）. Conclusion The phacoemulsification through the two different surgical incisions can significantly improve the visual quality of patients, but the scleral tunnel incision results in less damage to the corneal endothelial,the corneal astigmatism and the BCVA are better,which shows high clinical value.