圆钝超声乳化针头在白内障超声乳化吸除术中的应用

Clinical application of phacoemulsification with a round blunt phaco tip

目的探讨圆钝超声乳化针头在白内障超声乳化吸除术中对手术效率和安全性的影响。设计前瞻性队列研究。研究对象2014年10月至2015年12月在郑州大学第二附属医院诊断为年龄相关性白内障并行白内障超声乳化吸除术的患者342例(406眼)。方法根据Emery核硬度分级标准将术眼分为非硬核组(Ⅲ级及以下)和硬核组(Ⅳ级及以上),两组术眼分别随机分为圆钝针头组(圆钝超声乳化针头)和锋利针头组(锋利超声乳化针头),并使用相应超声乳化针头进行手术。主要指标手术总时间、平均超声能量、累积超声时间、有效超声时间、后囊膜破裂率及术后第1天较术前中央角膜厚度增加量。结果非硬核组及硬核组中,两超声乳化针头组的患者年龄、性别等基本信息均无统计学差异(P均>0.05)。非硬核组中,两超声乳化针头组术中各项指标均无统计学差异(P均>0.05)。硬核组中,圆钝针头组较锋利针头组使用更多的平均超声能量(42.2%±5.1%、38.9%±6.4%,P=0.004)及有效超声时间(15.53 s±3.47 s、13.34 s±3.18 s,P=0.001),其余术中指标均无统计学差异(P均>0.05)。总体后囊膜破裂率为4.18%,非硬核组和硬核组分别为3.79%、5.17%。非硬核组中圆钝针头组的后囊破裂率(1.42%)明显小于锋利针头组(6.52%)(P=0.035),硬核组中圆钝针头组的后囊破裂率(1.78%)亦小于锋利针头组(9.26%),但差异无统计学意义(P=0.225)。非硬核组中两超声乳化针头组中央角膜厚度增加量无统计学差异(78.5μm±50.6μm,71.6μm±53.3μm,P=0.263),硬核组中圆钝针头组中央角膜厚度增加量(220.8μm±36.3μm)大于锋利针头组(198.4μm±53.1μm)(P=0.011)。结论圆钝超声乳化针头在白内障超声乳化吸除术中可减少后囊破裂的发生,但对硬核者增加了超声能量和有效超声时间。

Objective To determine the influence of round blunt phaco tips on efficiency and safety in conventional phacoemulsification. Design Prospective cohort study. Participants This study enrolled 406 eyes of 342 senile cataract patients who had undergone phacoemulsification between October 2014 and December 2015 in the Second Affiliated Hospital of Zhengzhou University. Methods The eyes were divided into 2 groups according to its nuclear hardness, and phacoemulsification in each group was performed with round blunt phaco tips or standard phaco tips randomly. Main Outcome Measures Surgical time （ST）, average ultrasound energy （AVE）, accumulative phaco time （APT）, effective phaco time （EPT）, the rate of posterior capsule rupture and the central corneal thickness （CCT） preoperatively and postoperatively at 1 day. Results Clinical characteristics such as age and sex were similar in both tip groups of each nuclear hardness group （all P〉0.05）. There was no statistical difference in all of intraoperative parameters between the two tip groups for patients with non-hard nuclear （all P〉0.05）. In hard nuclear group, AVE （42.2%±5.1%, 38.9%±6.4%, P=0.004） and EPT（15.53±3.47 s, 13.34±3.18 s, P=0.001） were significantly higher in round blunt phaco tip group than in standard phaco tip group. But the rest of intraoperative parameters showed no difference between different tip groups （all P〉0.05）. The overall incidence of posterior capsule rupture was 4.18%, with 3.79% in non-hard nuclear group and 5.17% in hard nuclear group respectively. In non-hard nuclear group, the incidence of posterior capsule rupture was 1.42% and 6.52% with round blunt phaco tips and standard phaco tips respectively （P=0.035）. In hard nuclear group, the incidence of posterior capsule rupture was 1.78% and 9.26% with round blunt phaco tips and standard phaco tips （P=0.225）. The change in CCT was similar in both tip groups for non-hard nuclear group （78.5±50.6 μm, 71.6±53.3 μm, P=0.263）.But for hard nuclear patients, the change in CCT was significantly thicker in tile round blunt phaco lip group （220.8±36.3 μm）, than that of traditional tip group （98.4±53.1 μm,P=-0.01）. Conclusion The round bhmt phaco tip is a reliable and safe option in phacoemulsification, the rate of posterior capsule rupture can be reduced, but the average ultrasound energy and effective phaco time were increased for hard nuclear.