小瞳孔白内障超声乳化手术中应用MalyuginRing瞳孔扩张器的效果

The Effect of Malyugin Ring in Phacoemulsification Surgery of Cataract with Small Pupil

目的：评价小瞳孔白内障超声乳化手术中应用MalyuginRing瞳孔扩张器的效果。方法：前瞻性病例对照研究。收集临床工作中的小瞳孔白内障患者27例（32眼），分为2组，其中术中采用2把器械瞳孔撕开操作21眼（Ⅰ组），采用MalyuginRing瞳孔扩张器扩张瞳孔11眼（Ⅱ组）。所有病例均行3．2mm透明角膜切口超声乳化白内障吸除IOL植入术，术后1周，1、3、6个月随访，比较手术前后最佳矫正视力（BCVA）、眼压（10P）、平均角膜曲率、角膜内皮细胞计数、瞳孔大小变化。采用独立样本t检验进行统计分析。结果：所有手术均由同一医师顺利完成，人工晶状体（IOL）100％囊袋内植入，无手术并发症发生。手术前与术后6个月比较：BCVA（LogMAR）：Ⅰ组1．15±0．75w．0．30±0．21，Ⅱ组1．42±1．16W0．30±0．31；IOP：Ⅰ组（14．7±4．6）mmHgw．（14．1±6．4）mmHg，Ⅱ组（16．1±5．1）mmHg vs．（12．4±2．2）mmHg；平均角膜曲率：Ⅰ组（44．55±1．83）D vs．（44．94±2．70）D，Ⅱ组（44．72±1．55）D vs．（45．37±1．25）D；角膜内皮细胞计数：Ⅰ组（2490±498）／mm2 vs．（1486±612）／mm2，Ⅱ组（2620±989）／mm2vs（2089±729）／mm2；瞳孔直径：Ⅰ组（2．0±0．6）mm vs．（3.3±1．2）／mm,Ⅱ组（2．2±0．8）mnlⅧ．（3．5±1．2）mm。2组间手术前后参数比较，术后角膜内皮细胞计数差异具有统计学意义（t=-2．352，P=0．038），其他参数比较差异均无统计学意义。结论：小瞳孔白内障超声乳化手术时使用MalyuginRing瞳孔扩张器辅助不影响术后视力恢复和IOP及角膜曲率情况。术后瞳孔较术前扩大，MalyuginRing有助于减少术中角膜内皮细胞丢失。

Objective： To assess the effect of Malyugin rings in phacoemulsification surgery of cataract in eyes with small pupils. Methods： This was a prospective ease-control study. Twenty-seven microcoria cataract cases （32 eyes） were enrolled and divided into two groups. In Group Ⅰ（21 eyes）, the pupils were dilated by with two instruments. In Group Ⅱ （Ⅱ eyes）, the pupils were dilated by Malyugin ring insertion. Clear corneal incisions of 3.2 mm were used in the phacoemulsifications. All cases were followed up postoperatively at 1 week and at 1, 3, and 6 months. Pre- and postoperative values were compared for best corrected visual acuity （BCVA）, intraocular pressure, corneal endothelial cell counts, and pupil size. Independent-samples t-tests were used in the analyses. Results： All surgery was completed successfully by the same doctor. All intraocular lenses were implanted within the capsule, and no complications occurred. Measurements for the following pre- and 6-month postoperative parameters were compared： BCVA （LogMAR）： Group Ⅰ, 1.15±0.75 vs. 0.30±0.21 and Group Ⅱ, 1.42±1.16 vs. 0.30±0.31; IOP （mmHg）： Group Ⅰ, 14.7±4.6 vs. 14.1±6.4 and Group Ⅱ, 16.1±5.1 vs. 12.4±2.2; Average corneal curvature （diopter, D）： Group Ⅰ, 44.55±1.83 vs. 44.94±2.70 and Group Ⅱ, 44.72±1.55 vs. 45.37±1.25; Corneal endothelial cell density （cells/mm2）： Group Ⅰ, 2 490±498 vs. 1 486±612 and Group Ⅱ, 2 620±989 vs. 2 089±729; Pupil diameter （mm）： Group Ⅰ, 2.0±0.6 vs. 3.3±1.2 and Group Ⅱ, 2.2±0.8 vs. 3.5±1.2. The parameters of the corneal endothelial cells were statistically different （t=-2.352, P=-0.038） after surgery between the two groups, and no statistical difference was found in the other parameters. Conclusions： Use of the Malyugin ring in microcoria cataract phacoemulsification does not affect the 6-month postoperative visual acuity, intraocular pressure, or average corneal curvature. The pupils were enlarged before surgery. Malyugin ring can help reduce the loss of corneal endothelial cells in surgery.