角膜拱形刀及角膜平刀行白内障超声乳化摘除术主切口的对比研究

Clinical evaluation of effects of arched blades for corneal incisions in cataract surgeries

目的分析白内障超声乳化摘除术中以拱形刀行透明角膜主切口对手术治疗效果的影响。方法选取2014年1月至2015年8月在深圳市眼科医院同意并接受白内障超声乳化摘除联合折叠式人工晶状体植入术的老年性未熟期白内障患者,将其中完成术前1 d,术后1、7、30 d完整随访的患者82例(91只眼)纳入统计资料。术前采用随机法将91只眼分为两组:观察组行角膜拱形刀主切口40例(46只眼),对照组行角膜平刀主切口42例(45只眼)。术前详细记录每位患者的性别、年龄、核硬度分级、视力、角膜散光等数据;术中记录超声乳化时所使用的平均超声能量和有效超声时间、记录前房稳定性,同时记录术中出现的手术并发症等情况;术后对两组患者进行视力、角膜散光检查,并同时记录角膜水肿消退时间及术后并发症等情况。结果两组术前及术后1、7、30 d裸眼视力无显著差异,两组术前及术后1、7 d平均散光度差异无统计学意义(P>0.05);观察组术后30 d的平均散光度为(0.57±0.29)D,对照组为(0.86±0.41)D,观察组明显低于对照组(P<0.05)。观察组前房稳定率明显高于对照组(P<0.05)。术中所使用的平均超声能量及有效超声时间、术后角膜水肿的发生率、术中及术后并发症发生率,两组没有显著性差别。结论以角膜拱形刀行白内障超声乳化主切口可降低术后30 d的角膜散光,增加术中前房稳定性,是一种安全有效的手术方式。

Objective To study clinical outcomes of arched blades used for corneal incision in cataract surgeries.Methods This prospective study investigated 91 eyes of 82 patients who underwent cataract surgeries between January2014 and August 2015. Temporal clear corneal incisions were made with either a 3. 2-mm conventional flat blade（ 45 eyes of 42 patients） or an arched blade（ 46 eyes of 40 patients）. The choice of knife was randomly assigned. Age,gender,visual acuity,and corneal refractive condition were recorded before surgery. Ultrasonic energy and effective phacoemulsification time,stability of anterior chamber during the operation were recorded. Visual acuity,corneal refraction,corneal edema and complications were recorded at 1 day,1 week,1 month postoperatively. Results There was no significant difference in visual acuity between the two groups. Cornea astigmatism was significantly lower in the arched blade group（ 0. 57 ± 0. 29D） than in the flat blade group（ 0. 86 ± 0. 41D） at 30 days after surgery. There was no significant difference in ultrasonic energy,effective phacoemulsification time,and the rate of complications. Stability of anterior chamber was better in the flat blade group（ P〈0. 05）. Conclusion Our results showed that corneal incision made with arched blades is effective in reducing surgically induced astigmatism and improvement of anterior chamber stability after cataract surgery. It also leads to better wound healing and better overall outcomes.