飞秒激光辅助的白内障手术对硬核白内障的临床效果研究

Clinical efficacy analysis of femtosecond laser-assisted phacoemulsification in hardness lens nucleus cataract

目的探讨飞秒激光辅助的白内障超声乳化吸除术对Ⅲ、Ⅳ级核白内障的临床效果。方法回顾性分析2013年9月至2015年9月来我院就诊的168例（182只眼）Ⅲ级和Ⅳ级核的白内障患者，根据术式分为飞秒激光组和传统超乳组，比较两组患者治疗效果。结果术后1周、1个月、3个月飞秒激光组的最佳矫正视力均优于传统超乳组（P〈0．05）。Ⅲ级核组，术后1个月及3个月飞秒激光组的角膜内皮细胞丢失率均低于传统超乳组（P〈0．05），Ⅳ级核组，两组结果无异（P〉0．05）。Ⅲ级核组，飞秒激光组CDE值较传统超乳组减少47．6％；核硬度为Ⅳ级时，飞秒激光组CDE值大于传统超乳组，但两组间差异无统计学意义（P〉0．05）。飞秒激光组的术源性散光小于传统超乳组（P〈0．05）。结论飞秒激光辅助的白内障超声乳化吸除术较传统超声乳化吸除术术后视力更好，术源性散光更小。对于Ⅲ级核的白内障患者，行飞秒激光辅助的白内障手术能够减少超声乳化能量的使用，减轻对角膜内皮细胞的损伤；当核硬度为Ⅳ级时，两种术式CDE值和角膜内皮细胞丢失率结果无异。

Objective To compare the clinical efficacy of femtosecond laser-assisted phacoemulsi-fication and traditional phacoemulsification in grade Ⅲ and grade IV hardness lens nucleus cataract. Methods In this retrospective study, 168 patients （182 eyes） whose nucleus hardness was grade Ⅲ and grade IV were divided into femtosecond group and traditional group according to different opera-tion methods. Nucleus hardness, cumulative dissipated energy （CDE）, best corrected visual acuity （BCVA）, corneal endothelial cell density, Calculate corneal endothelial cell loss rates, surgically in-duced astigmatism （SIA）, and complications were recorded. Results The BCVA of femtosecond group at 1 week, 1 month and 3 months after operation were better than that in traditional group. For grade Ⅲ nucleus, the corneal endothelial cell loss rates at 1 month and 3 months after opera-tion of femtosecond group were lower than that in traditional group （P 〈0.05）, for grade IV nucle-us, there was no significant difference between the two groups. For grade Ⅲ nucleus, the CDE val-ue in femtosecond group was reduced by 47.6% than the CDE value in traditional group. For grade IV nucleus, the CDE value in femtosecond group was larger than that in traditional group, but there was no significant difference. The SIA va1ue in femtosecond group was less than that in traditional group （P 〈0.05）. Conclusions The postoperative visual acuity of femtosecond laser-assisted phaco-emulsification is better than that in traditional phacoemulsification. Femtosecond laser-assisted phaco-emulsification led to less surgically induced astigmatism. For grade Ⅲ nucleus cataract patients, fem-tosecond laser-assisted phacoemulsification can reduce ultrasonic emulsification energy and lower the injury of corneal endothelial cell. For grade IV nucleus cataract patients, there is no significant differ-ence in the CDE value and the corneal endothelial cell loss rate between the two operation meth- ods.