Phaco drill术式治疗硬核白内障效果分析

Analysis of power combination index of Phaco drill and its effect on corneal endothelium

目的通过比较超声能量功效学指标及对角膜内皮影响，分析Phacodrill术式治疗硬核白内障效果。方法测量并记录于2011年10月至2014年6月在无锡市人民医院眼科就诊的按患眼白内障分级，选取白内障Ⅳ级（硬核）核患眼60例，由同一术者顺利完成的超声乳化手术，术中均采用拦截-劈裂技术，其中乳化针头斜面向上完成晶状体核去除的患眼30只眼（A组），乳化针头斜面向下完成晶状体核去除（Phaco drill术式）的患眼30只眼（B组），记录术中超声能量（％）及时间（s），两项参数的乘积记录为能量合成值；记录术前、术后1周角膜内皮细胞计数和角膜内皮正常六边形细胞比率变化。结果A组能量合成值为1204．12±137．16，B组能量合成值为828．87±97．14，B组能量合成值显著低于A组，差异有统计学意义（t=23．72，P〈0．01）。A组术后1周角膜内皮细胞计数较术前减少（19．69±5．11）％；B组术后1周角膜内皮细胞计数较术前减少（10．82±4．78）％，显著低于A组，差异有统计学意义（t=19．59，P〈0．05）；术后1周第A、B组角膜内皮正常六边形细胞比率分别较术前下降（20．33±3．47）％、（11．88±4．21）％，其中B组比率显著低于A组，差异有统计学意义（t=24.21，P〈0．01）。结论在白内障硬核的超声乳化手术中，Phaco drill术式能量合成值较低，患眼术后角膜内皮计数减少较少，维持正常六边形细胞比率较高。

Objective To analyze power combination index of Phaco drill and its effect on corneal endothelium. Methods Same surgeon performed 60 phacoemulsification surgeries with stop-chop technique in cataract eyes with level IV nucleus. Among them, 30 phacoemulsification were performed with bevel up phaco tip （group A）, 30 were performed with bevel down phaco tip （Phaco drill technique） （group B）. Phaco power （%） and time （S） were recorded for each surgery. Power combination index was calculated as power X time. Endothelial polymegathism and pleomorphism were measured before and 1 week after surgery. Results Power combination index of group A was 1204.12±137.16. Power index of group B was 828.87±97.14. Power index of group B was significantly lower than that of group A （t =23.72, P 〈0.01）. Endothelial cells decreased 19.69±5.11% 1 week after surgery in group A, and 10.82±4.78 in group B. The difference was statistically significant between group A and B （t =19.59, P 〈0.05）. The percentage of corneal endothelial hexagonal cells was decreased 20.33±3.47%, 11.88±4.21% in group A and B, respectively. The difference was statistically significant between group A and B （t =24.21, P 〈0.01）. Conclusions For cataract with hard nucleus, Phaco drill technique lead to lower power combination index, cause less corneal endothelial injury.