两种不同切口同轴白内障超声乳化术的临床分析

Clinical analysis of two different incisions of coaxial phacoemulsification

目的:评价2.2mm同轴微切口白内障超声乳化手术与3.0mm同轴超声乳化手术的临床效果。方法:随机将67例80眼年龄相关性白内障患者分成两组,A组40眼行2.2mm同轴微切口白内障超声乳化人工晶状体植入术;B组40眼行3.0mm同轴小切口白内障超声乳化人工晶状体植入术。并对两组有效超声乳化时间和平均超声能量、角膜内皮细胞计数、角膜水肿情况、角膜散光、术后视力及术后并发症进行比较。结果:两组术眼的有效超声乳化时间:A组为8.18±11.22s,B组为7.82±2.12s,两组比较差异无统计学意义(P>0.05)。平均超声能量:A组为(17.25±4.22)%,B组为(17.64±4.27)%,两组比较,差异无统计学意义(P>0.05)。术后1wk两组术眼角膜内皮细胞与术前相比,内皮细胞减少,差异无统计学意义(P>0.05)。术后第1d,两组部分患者术眼角膜水肿,其中A组共有9眼,B组共有6眼,3～5d后角膜水肿减轻或消退。术后1wk两组角膜散光改变差异具有统计学意义(P<0.05),而术后1、3mo差异无统计学意义(P>0.05);A组手术前后角膜散光改变不明显,差异均无统计学意义(P>0.05);B组手术前后角膜散光改变明显,差异有统计学意义(P<0.05)。在术后1、3mo后,两组各自散光的又趋于稳定,术后1、3mo两组角膜散光改变,差异无统计学意义(P>0.05)。术后1d,1 wk,1 mo两组患者的裸眼视力差异均具有统计学意义(P<0.05),而术后3mo两组裸眼视力差异均无统计学意义(P>0.05)。结论:对于软性或中等度硬核,2.2mm同轴微切口白内障与传统的3.0mm同轴小切口白内障手术相比,能有效地减少手术源性散光,而且散光状态比较稳定,有利于视力的早期恢复。

AIM:To compare the clinical effects of 2.2mm coaxial micro-incision and 3.0mm standard incision in cataract phacoemulsification surgery.METHODS:A total of 67 patients(80 eyes)were randomly divided into two groups.Cataract phacoemulsification and artificial lens implantation surgery was carried out with 2.2mm coaxial micro-incision(Group A,40 eyes)and 3.0 mm standard incision(Group B,40 eyes),respectively.The effective phacoemulsification time and average ultrasound energy,corneal endothelial cell count,corneal edema,corneal astigmatism,postoperative visual acuity and postoperative complications were compared between the two groups.RESULTS:Effective phacoemulsification time of Group A and Group B was 8.18~11.22s and 7.82~2.12s,respectively,and the difference had no statistical significance(P>0.05);average ultrasonic energy was(17.25~4.22)%and(17.64~4.27)%,respectively,and the difference was not statistical significance(P>0.05).There was no significant difference in endothelial cells between the two groups of corneal endothelial cells at 1wk after surgery compared with that before operation(P>0.05).On the first day after surgery,corneal edema was observed in some patients.There were 9 eyes in Group A,6 eyes in Group B,corneal edema relief or subsidence after 3d to 5d.There was significant difference in corneal astigmatism change between the two groups at 1wk(P<0.05),but there was no significant difference at 1 and 3mo after operation(P>0.05).The changes of corneal astigmatism before and after operation in Group A were insignificant(P>0.05),while the changes of corneal astigmatism before and after operation in Group B were significantly different(P<0.05).At 1 and 3mo after operation,the astigmatism of each group tended to be stable,and the corneal astigmatism in the two groups after 1 and 3mo had no statistical significant difference(P>0.05).The uncorrected visual acuity(UCVA)differences of the two groups was statistically significant at 1d,1wk and 1mo after operation(P<0.05),but there was no significant difference between the two groups in UCVA after 3mo(P>0.05).CONCLUSION:For soft or medium-hard nucleus cataract,compared with the traditional 3.0mm small-incision coaxial phacoemulsification,the 2.2mm micro-incision coaxial phacoemulsification can effectively reduce the surgically induced astigmatism,and the astigmatism state is relatively stable,and conducive to early recovery of visual acuity.