印度规范化手法小切口白内障手术的学习曲线

Learning curve of Indian standardized manual small-incision cataract surgery

目的:探讨印度规范化手法小切口白内障手术(manual small-incision cataract surgery,M-SICS)的学习曲线。方法:收集2012-12/2014-12年龄相关性白内障253例295眼,按手术时间先后分为A、B、C三组,A组为培训组,B、C组为强化组。所有病例均由同一初学白内障手术者行M-SICS。分析三组术后最佳矫正视力、术中及术后并发症,评价手术效果,探讨SICS的学习曲线。结果:术后1wk三组脱盲率均为100%,脱残率分别为93.7%、93.0%、91.0%。A、B、C三组主要并发症发生率分别为2.1%、7.0%、3.0%;后囊膜破裂占到所有并发症的50%。未发生核块或IOL坠入玻璃体腔、眼内炎、角膜内皮功能失代偿、驱逐性脉络膜出血等严重并发症。结论:印度手法小切口白内障手术安全有效,规范化培训可缩短学习曲线,减少并发症,值得借鉴。

AIM： To explore the learning curve of the Indian standardized manual small- incision cataract surgery （SICS）. METHODS： Totally 253 cases （295 eyes） of senile cataract were divided into three groups （Group A： training group, Group B and C： strengthened groups） according to the operation time from December 2012 to December 2014. All cases were performed with manual SlCS by the same trainee ophthalmologist. To research the learning curve of manual SlCS and evaluate surgical effects, the best corrected visual acuity and complications were observed. RESULTS： At lwk postoperatively, the rate of relief from blindness in all three groups after operation were 100%, the rate of relief from visual handicap in group A, B, C were 93. 7%, 93. 0% and 91. 0% respectively. Complication rates were 2. 1%, 7. 0% and 3. 0% respectively in three groups. Posterior capsular rupture accounted for 50% of all complications. No severe postoperative complications were found, such as nucleus or IOL falling into vitreous cavity, endophthalmitis, corneal endothelial function dysfunction and expulsive choroidal hemorrhage. CONCLUSION： Manual SlCS is safe and effective. Because of helping to shorten the learning curve and decrease the incidence of complications, the standardized manual SICS training is worth using for reference.