撕囊镊预劈核技术在白内障超声乳化中的应用

Pre-chopping with capsulorhexis forceps in the cataract phacoemulsification

目的评价撕囊镊预劈核技术在白内障超声乳化手术中的应用效果。方法将年龄相关性白内障超声乳化手术患者192例(196只眼),根据手术方式不同随机分为预劈核组98例(99只眼)和拦截劈核组94例(97只眼)。预劈核组:不进行水分离,采用撕囊镊直接将核分成4块后直接进行超声乳化;拦截劈核组:水分离后,采用传统拦截劈核法进行劈核和超声乳化。术中设定负压和能量均相同。观察比较2组患者手术前后角膜内皮细胞密度的变化,术中平均超声乳化时间,术后角膜水肿和视力恢复情况,以及手术并发症发生情况。结果 (1)角膜内皮细胞密度:预劈核组与拦截劈核组术后1周角膜内皮丢失率分别为(10.52±9.12)个/mm^2和(17.26±19.01)个/mm^2,差异有统计学意义(P<0.05)。(2)术中平均超声乳化时间:预劈核组与拦截劈核组分别为Ⅲ级(35.45±4.9)s、Ⅳ级(47.1±9)s和Ⅲ级(46.78±5.5)s、Ⅳ级(60.21±15)s,均有统计学差异(P<0.05);(3)术后角膜水肿程度:预劈核组术后1 d和1周发生角膜水肿者分别为37只眼和22只眼,明显低于拦截劈核组60只眼和42只眼(P<0.05);(4)术后视力恢复情况:术后1 d和术后1周2组患者的视力均有不同程度的提高,预劈核组恢复更明显(P<0.05)。(5)术中并发症:无悬韧带断离、后囊膜破裂等严重并发症。结论白内障超声乳化手术所采用的撕囊镊预劈核技术具有明显缩短超声乳化时间、操作简单方便、减少术中并发症、患者术后角膜水肿轻、角膜内皮细胞损失少和视力恢复快等优点,值得在临床中推广应用。

Objective To evaluate the technique of pre-choppingwith capsulorhexis forceps in the cataract phacoemulsification. Methods 192 of age-related cataract patients（ 196 eyes） received phacoemulsification surgery. Either nucleuspre-chopping（ 98 cases,99 eyes） orintercept chopping（ 94 cases,97 eyes） was used. Pre-chopping refers to thedividing of nucleus into 4 blocks with capsulorhexis forceps without water separation. In contrast,interceptchoppingwas done after water separation. Surgical parameters such as negative pressure and the energy of emulsificationwerekept same. Changes in corneal endothelial cell density,average emulsification time,postoperative corneal edema,visual acuity,and surgical complications were compared. Results（ 1） Corneal endothelial cell density reduction rate（ percentage） was 10. 52 ±9. 12 and 17. 26 ± 19. 01 in patients treated with pre-chopping or intercept chopping,respectively（ P〈0. 05）.（ 2） Average emulsification time were 35. 45 ± 4. 9 sec（ level III） and 47. 1 ± 9 sec（ level IV） in patients treated with pre-chopping,compared to 46. 78 ± 5. 5 sec（ level III） and 60. 21 ± 15 sec（ level IV） in patients treated with intercept chopping（P〈0. 05）.（ 3） Rates of postoperative corneal edema at 1 day and 1 week were significantly lower in pre-chopping group（ 37 and 22 cases,respectively） than in intercept chopping group（ 60 and 42 cases,respectively,P〈0. 05）.（ 4） Vision recovery was more significant in pre-chopping group at 1 day and 1 week after surgery（ P〈0. 05）.（ 5） No serious complications in all patients. Conclusions Capsulorhexis forceps pre-choppingcould significantly shorten the time of emulsification,reduce complications,improve postoperative corneal edema,minimize corneal endothelial cell loss,and facilitate vision recovery.