向上劈核技术在硬核性白内障手术中的应用

PHACO FORWARD-CHOP TECHNIQUE FOR MANAGING POSTERIOR NUCLEAR PLATE OF HARD CATARACT

目的:评价劈核钩向上劈核技术在硬核白内障超声乳化手术中的有效性和安全性。方法:对115例128眼Emery-Little分级为Ⅳ级核的硬核性白内障病人行超声乳化白内障吸除联合人工晶状体植入术,其中65只眼使用劈核钩向上劈核技术(向上劈核组),63只眼使用标准的拦截劈核技术(对照组),记录术中所使用的超声时间、超声能量和累积能量复合参数,并比较术后最佳矫正视力、角膜内皮计数和并发症。结果:向上劈核组的超声时间(23.02±6.91s)、超声能量(15.72%±2.79%)及累积复合能量参数(6.02±2.05)均明显低于对照组,差异均有统计学意义(P<0.05)。向上劈核组术后1d和术后3d角膜水肿程度明显低于对照组,差异均有统计学意义(P<0.05)。向上劈核组术后1wk角膜内皮细胞损失率(9.07%±3.03%)明显低于对照组(15.32%±3.06%),差异有统计学意义(P<0.05)。结论:劈核钩向上劈核技术可使超声乳化白内障吸除术的超声时间缩短和超声能量降低,从而减轻眼内组织损伤,提高手术疗效,值得推广使用。

Objective：To evaluate the effectiveness and safetyof phaco forward-chop technique for managing hard cataract. Methods：128eyes of 115 cases with IV stage hard cataract according to Emery-Little staging performed phacoemulsification combined with intraocular lens implanation. 65eyes in forward-chop group performed Phaco forward-chop technique and 63 eyes with standard s and stop-and-chop technique as controls. The ultrasound Time（ UST） ,Cumulative Dissipated Energy（ CDE） and accumulated energy complex parameter（ AECP） were recorded. The best corrected visual acuity,corneal endothelial count and complications were compared between forward-chop group and control group. Results：The UST, CDE and AECP in forward-chop group was separately 23. 02%± 6. 91 seconds, 15. 72%±2. 79%and 6. 02±2. 05,which was lowef than those in control group. The difference between them was significant（P〈0. 05）. The corneal edema in forward-chop group was less at 1 d and 3 d after surgery（P〈0. 05）. The rate of loss corneal endothelial count was lower than control（9. 07 ±3. 03%verus 15. 32%±3. 06%,P〈0. 05）. Conclusion：With less ultrasound time and enegy,phaco forward-chop technique was superior in managing posterior nuclear plate of hard cataract. This technique may reduce intraocular injury,improve surgical effectiveness. It should be recommended.