改善白内障超声乳化手术透明角膜切口方法的研究

Study on the method of improving transparent corneal incision for cataract phacoemulsification surgery

目的研究改善白内障超声乳化手术透明角膜的切口方法。方法 84例(84只眼)单纯年龄相关性白内障患者,按照随机数字表法分为A组(20例20眼)、B组(32例32眼)和C组(32例32眼)。A组行常规颞侧3.2 mm单平面透明角膜主切口,再做侧切口。B组做颞侧3.2 mm单平面透明角膜主切口,注入粘弹剂,然后完成余下步骤。C组(改良组)做侧切口,注入粘弹剂,再做颞侧双平面透明角膜主切口。术后1 d、1周及1个月观察角膜切口情况。结果三组术后视力、眼压及角膜切口处厚度比较差异均无统计学意义(P>0.05)。术后1 d、1周及1个月C组角膜切口长度均长于A组和B组,差异有统计学意义(P<0.05)。C组角膜切口角度为(35.81±4.70)°,均小于A组的(42.65±3.96)°和B组的(36.41±5.09)°,差异有统计学意义(P<0.05)。术后1 d及1周时三组角膜内皮裂隙发生率比较差异有统计学意义(P<0.05),术后1个月时三组角膜内皮裂隙发生率比较差异无统计学意义(P>0.05)。术后1 d及1周时角膜后弹力层脱离发生率比较差异有统计学意义(P<0.05),术后1个月时三组角膜后弹力层脱离发生率比较差异无统计学意义(P>0.05)。结论在透明角膜切口白内障超声乳化手术中,通过改良制作手术切口的方法可改善透明角膜切口质量。

Objective To study the method of improving transparent corneal incision for cataract phacoemulsification surgery. Methods A total of 84 simple age related cataract patients（84 eyes） were divided by random number table method into group A（20 cases, 20 eyes）, group B（32 cases, 32 eyes） and group C（32 cases, 32 eyes）. Group A received conventional temporal 3.2 mm single plane clear corneal incision and side incision, group B received temporal 3.2 mm single plane clear corneal incision, viscoelastic agent injection and the remaining steps, and group C（improved group） received side incision, viscoelastic agent injection and temporal biplane transparent corneal incision. Corneal incision was observed at 1 d, 1 week and 1 month after operation. Results Three groups had no statistically significant difference in postoperative visual acuity, intraocular pressure and corneal incision thickness（P〉0.05）. At 1 d, 1 week and 1 month after operation, group C had longer corneal incision length than group A and group B, and their difference was statistically significant（P0.05）. Group C had less corneal incision angle as（35.81±4.70）° than（42.65±3.96）° in group A and（36.41±5.09）° in group B, and their difference was statistically significant（P〈0.05）. At 1 d, 1 week after operation, three groups had no statistically significant difference in incidence of corneal endothelial fissure（P〈0.05）. Three group had no statistically significant difference in incidence of corneal endothelial fissure at 1 month after operation（P〉0.05）. There was statistically significant difference in incidence of posterior corneal elastic detachment at 1 d and 1 week after operation（P〈0.05）. Three groups had no statistically significant difference in incidence of posterior corneal elastic detachment at 1 month after operation（P〉0.05）. Conclusion In cataract phacoemulsification surgery with transparent corneal incision, the quality of transparent corneal incision can be improved by improving the method of making surgical incision.