白内障超声乳化吸除术对视觉及眼压和角膜散光的影响

Effect of phacoemulsification on visual and intraocular pressure and corneal astigmatism

目的:探讨超声乳化联合人工晶状体植入术切口位置选择对白内障患者视觉功能、眼内压及角膜散光的影响。方法:选取于我院治疗的白内障患者72例,共计85眼进行观察,入选患者均行白内障超声乳化联合人工晶状体植入术治疗,据手术切口位置不同分为观察组(n=36,43眼)及对照组(n=36,42眼),观察组在最大角膜屈光力子午线轴位做3.0mm透明角膜切口,对照组于颞上侧或鼻上侧做3.0mm常规透明角膜切口,术后2组均给予常处置,术后进行随访,比较2组手术前后最佳矫正视力(BCVA)、眼压、角膜散光度及角膜内皮细胞计数。结果:2组术后BCVA与术前比较呈逐渐升高趋势,角膜内皮细胞计数呈明显降低趋势(P<0.01),但2组间BCVA及角膜内皮细胞计数均无明显差异(P>0.05);2组眼压术后先升高后降低趋势,术后2h、1d眼压明显高于术前(P<0.01),术后2d眼压与术前无明显差异(P>0.05),但2组间术后各时间点眼压均无明显差异(P>0.05);2组角膜散光度于术后呈先升高后降低趋势,手术源性散光度于术后7d^6个月呈逐渐降低趋势,且术后7d^6个月观察组平均角膜散光度均低于对照组(P<0.01),术后1个月~6个月观察组手术源性散光度低于对照组(P<0.05)。结论:白内障超声乳化联合人工晶状体植入术中选择最大角膜屈率位和常规手术切口均可改善患者的视力,但最大角膜屈率位手术切口可减小患者术后角膜散光度,具有一定优势。

Objective：To investigate the effect of phacoemulsification combined with intraocular lens implantation on visual function,intraocular pressure and astigmatism in patients with cataract.Methods：A total of 72 patients with cataract treated in our hospital from April 2015 to October 2016,a total of 85 eyes of whom were observed.All patients underwent phacoemulsification and intraocular lens implantation.According to the position of incision,they were divided into observation group（n=36,43eyes）and control group（n=36,42eyes）.In the observation group,at the maximum refractive power radial axis,3mm clear corneal incision was done;in the control group,at the temporal side or side nasal,3routine mm clear corneal incision was done after operation.Two groups were given regular treatment.Follow-up after operation,the best corrected visual acuity（BCVA）,intraocular pressure,corneal astigmatism and corneal endothelium cell of the two groups were compared before and after surgery.Results：After surgery,two groups of postoperative BCVA increased gradually;the quantity of corneal endothelial cell was significantly reduced（P〈0.01）;but there were no significant differences of BCVA and corneal endothelial cell between the two groups（P〉0.05）.Intraocular pressure after operation in two groups was increased first and then decreased after 2h;1 d the intraocular pressure was significantly higher than that before operation（P〈0.01）;2 d after operation and preoperative intraocular pressure had no significant difference（P〉0.05）;but between the two groups,there were no significant differences（P〉0.05）at each time point after operation.After operation,the two groups of corneal astigmatism increased at first and then decreased;surgically induced astigmatism decreased gradually 7dto 6months after operation,and the average corneal astigmatism of the observation group were lower than the control group（P〈0.01）.Surgically induced astigmatism of the observation group is lower than that of the control group 1-6months after operation（P〈0.05）.Conclusion：the choice of the maximum rate of corneal and conventional surgical incision can improve visual acuity in patients with cataract phacoemulsification and intraocular lens implantation,but the maximum rate of a corneal incision can reduce the degree of corneal astigmatism after surgery,which has certain advantages.