某农村地区两种手法小切口白内障手术临床研究

Clinical study on two kinds of manual small incision cataract surgery in rural areas

目的通过回顾性分析,比较两种不同手法小切口白内障摘除联合人工晶体植入术后的情况,包括视力、角膜水肿程度与眼表功能,探讨农村地区白内障手术的有效途径。方法以反眉形小切口为治疗组,以平行内外眦连线的直小切口为对照组。术前常规检查。术后3 d、1个月、3个月检查患者裸眼视力、角膜水肿情况;通过眼表疾病指数(ocular surface disease index,OSDI)评分了解眼表功能情况。结果两组术前基线情况基本一致(P>0.05)。术后3 d及1个月,治疗组视力低于对照组(P<0.05);术后3 d,治疗组角膜水肿发生率高于对照组(P<0.05);术后3个月的视力比较以及术后1个月、3个月的角膜水肿情况比较均无明显差异(P>0.05);术后3 d及1个月治疗组OSDI评分与对照组比较,无明显差异(P>0.05)。术后3个月,OSDI评分治疗组低于对照组(P<0.05)。结论反眉形小切口与直小切口各有优缺点,均具有较好的手术疗效,适合基层医院推广。术者应根据晶体核的硬度,选择合适的切口,尽可能减少并发症的发生并增进视力,改善眼表功能。

Objective:By retrospective analysis,the visual acuity,corneal edema and ocular surface function after cataract extraction with small incision combined with intraocular lens implantation were compared,and the effective ways of cataract surgery in rural areas were discussed.Methods:The treatment group was treated with a anti-eyebrow small incision while the control group was treated with a straight small incision,which was parallel to the medial and lateral canthus.Routine examination was performed before operation.At 3d,1mo and 3mo after surgery,the naked eye vision,corneal edema and OSDI(ocular surface disease index)score were examined.Results:The two groups were basically the same before operation(P>0.05).The visual acuity of the treatment group was lower than that of the control group 3d and 1mo after operation(P<0.05).The incidence of corneal edema in the treatment group was higher than that in the control group 3d after operation(P<0.05).There was no significant difference in visual acuity between the treatment group and the control group 3mo after operation(P>0.05).At 1 mo and 3 mo after operation,there was no significant difference in corneal edema between the treatment group and the control group(P>0.05).There was no significant difference in OSDI score between the treatment group and the control group at 3d and 1 mo after operation(P>0.05).At 3mo after operation,the OSDI score of the treatment group was lower than that of the control group(P<0.05).Conclusion:The anti-eyebrow small incision and the straight small incision have better surgical effect,and each of them has its own advantages and disadvantages.These two surgical methods are suitable for popularization in grass-roots hospitals.Operators should choose appropriate incision according to the hardness of lens nucleus to minimize complications and improve visual acuity and ocular surface function.