小切口撕囊镊劈核治疗老年硬核性白内障手术中的效果

The effect of small incision with capsulorhexis forceps in the treatment of senile hard nucleus cataract

目的观察小切口撕囊镊劈核治疗老年硬核性白内障手术中的效果。方法将接受小切口非超声乳化摘除人工晶状体植入手术的137例老年硬核性白内障137眼(Ⅳ~Ⅴ级核)随机分为A(44眼)、B(45眼)和C(48眼)三组,其中A和B组术中进行劈核,A组采用撕囊镊劈核,B组术中采用劈核刀劈核,C组不劈核。观察术中撕囊镊劈核效果、各组术后最佳矫正视力(1d、1w和1m)、手术源性散光值、角膜内皮细胞数量、角膜水肿、并发症及处理。结果撕囊镊劈核成功率100%。两两比较在术后各组最佳矫正视力无明显差异。各组手术源性散光在术后1d时最大,后随时间延长而缩小,1d、1w和1m时A组和B组手术源性散光与C组相比差异有统计学意义(P<0.05)。术后1d, A、B和C三组术眼发生角膜水肿分别为11眼(25.0%)、11眼(44.4%)和11眼(45.8%),两两相比,A组与B组和C组相比有明显差异(P<0.05)。三组术后无严重并发症发生。结论撕囊镊劈核无需特殊器械、操作简便、术后散光小,安全实用。

Objective To evaluate the effect of small incision chop with capsulorhexis forceps in the treatment of senile hard nucleus cataract.Methods 137 cases of senile hard nucleus cataract patients(137 eyes)were divided into 3 groups randomly:Group A(44 eyes),Group B(45 eyes)and Group C(47 eyes),they would accept small incision cataract surgery and their lens nucleus were grade IV-V.The nucleus would be chopped with capsulorhexis forceps in group A and with chopping knife in group B,and the nucleus was not chopped in group C.The post-operative effect of chopping nucleus with capsulorhexis forceps,best corrected visual acuity(at 1 d,1 w and 1 m),surgically induced astigmatism,number of corneal endothelial cells,corneal edema,complications and management were observed.Result The successful rate of chopping nucleus with capsulorhexis forceps was 100%.No significant difference of the best corrected visual acuity were found among the three groups postoperatively.Surgically induced astigmatism was the largest in each group at 1d and decreased gradually later,surgically induced astigmatism of group A and group B was significantly different from that of group C at 1d,1w and 1m(P<0.05).At 1 d after operation,corneal edema was 11 eyes in group A(25.0%),20 eyes(44.4%)in group B and 22 eyes(45.8%)in group C,respectively.The corneal edema in group A was significantly different from that in group C(P<0.05).No serious complications occurred in the three groups postoperatively.Conclusion Capsulorhexis forceps for chopping nuclei need no special instruments,and is easy to operate with less postoperative astigmatism,safe and practical.