预劈核和常规拦截劈核技术在超声乳化白内障摘除手术的应用比较

A comparison of prechop and conventional stop-and-chop techniques applied in phacoemulsification

目的:探讨预劈核技术和常规拦截劈核技术在超声乳化白内障摘除手术的应用,对比其临床疗效及对角膜内皮细胞的影响。方法:选取蚌埠医学院第一附属医院2016年1月至2017年4月收集的60例(60眼)白内障患者进行研究,根据手术方法分为A组30例(30眼,采用预劈核技术行超声乳化白内障摘除手术)、B组30例(30眼,采用常规拦截劈核技术行超声乳化白内障摘除手术),观察2组患者手术疗效及角膜内皮细胞变化情况。结果:A组实际超声能量[(50.36±2.47)%]明显低于B组[(55.42±3.28)%],A组有效超声时间[(56.56±10.20)s]明显低于B组[(67.79±11.45)s],差异具有统计学意义(P<0.05)。重复测量数据的方差分析显示,不同时间点的最佳矫正视力(best corrected visual acuity,BCVA)、角膜内皮细胞密度(endothelial cell density,ECD)和六角形细胞比例均有差别(P<0.05),2组的BCVA、ECD和六角形细胞比例测量时间和组别不存在交互作用(P>0.05)。术后1 d A组患者角膜水肿较B组轻,差异具有统计学意义(P<0.05);术后7 d 2组患者角膜水肿消退,差异无统计学意义(P>0.05)。结论:2种手术方式均具有良好的临床疗效,采用预劈核技术能有效降低白内障术中超声能量和超声时间,降低角膜内皮细胞损伤,且操作方便,值得临床推广。

Objective:To explore the application of prechop and conventional stop-and-chop techniques in phacoemulsification and to compare their clinical efficacy and effect on corneal endothelial cells. Methods:Sixty patients(60 eyes) with cataract collected from our hospital from January 2016 to April 2017 were enrolled in the study and were divided into group A(30 eyes,phacoemulsification performed using prechop technique) and group B(30 eyes,phacoemulsification performed using stop-and-chop technique) by surgical approach,with 30 cases in each group. Patients in both groups were observed for surgical effect and changes in corneal endothelial cells. Results :Group A had significantly lower actual ultrasonic energy and significantly shorter effective ultrasonic duration than group B[(50.36±2.47)% vs.(55.42±3.28)%,(56.56±10.20) s vs.(67.79±11.45) s,P<0.05]. A repeated measures analysis of variances showed that there were significant differences in the best corrected visual acuity,endothelial cell density,and proportion of hexagonal cells measured at different time points(P<0.05),with no time-group interaction effects observed in the above three indices in the two groups(P>0.05). Corneal edema was significantly milder in group A than in group B one day after operation(P<0.05);the corneal edema resolved seven days after operation with no significant difference observed between the two groups(P>0.05). Conclusion:Both surgical approaches have a good clinical effect;the prechop technique can effectively reduce ultrasonic energy and shorten ultrasonic duration in a cataract surgery;meanwhile,it can reduce the injury of corneal endothelial cells and is easy to operate. All these make it worthy of clinical application.