重力液流与主控液流对白内障超声乳化术术后视力恢复及视觉质量的影响

Effect of gravity fluidic system and active control fluidic system on visual acuity recovery and visual quality after phacoemulsification of cataract

目的比较重力液流与主控液流两种灌注方式下白内障超声乳化手术病人视力恢复及视觉质量的影响。方法选取2018年6月至2019年6月于安徽医科大学附属省立医院眼科因年龄相关性白内障行白内障超声乳化吸除联合人工晶体植入术的手术病人40例40眼。采用随机数字表法将病人分为试验组、对照组。试验组20例20眼术中采用主控液流系统(主控灌注)进行白内障超声乳化手术,对照组20例20眼采用重力液流系统(重力灌注)白内障超声乳化手术。分别记录术中超声能量的使用情况(CDE),术后1 d、1周、1月病人最佳矫正视力(BCVA)、角膜内皮情况[角膜内皮细胞密度(ECD)、中央角膜厚度(CCT)],使用iTrace分别测量术眼自然状态下瞳孔直径3 mm时的高阶像差及高阶像差下的调制传递函数(MTF),数据分析采用单因素方差分析。结果术前两组在一般资料比较,差异无统计学意义。两组术中的CDE比较试验组(5.54±0.91)s小于对照组(7.27±1.47)s(P<0.001)。两组BCVA在术后1 d、1周、1月差异有统计学意义(P<0.05)。两组ECD在术前、术后1 d、1周、1月均差异无统计学意义(P>0.05)。试验组在术后1 d、1周CCT均小于对照组,试验组在术后1 d、1周、1月的全眼(瞳孔直径3 mm)高阶像差及高阶像差下的MTF优于对照组,且均差异有统计学意义(P<0.05)。而两组的总高阶像差随着时间推移逐渐接近同一水平。结论主控灌注相较于传统的重力灌注在白内障超声乳化手术中能够减少超声能量的使用,减少角膜内皮损伤,进而减轻术后角膜水肿和高阶像差的改变,使病人获得更好的术后视力及视觉质量。

Objective To compare the effects of gravity fluidic and active fluidic on visual acuity recovery and visual quality in patients undergoing phacoemulsification.Methods Totally 40 eyes of 40 patients were selected,who underwent cataract phacoemulsification combined with intraocular lens implantation for age-related cataract in the Department of Ophthalmology,Anhui Medical University Affiliated Provincial Hospital from June 2018 to June 2019.Random number table method was used to randomly assign the patients into study group and control group.In the study group,20 cases(20 eyes)were treated with phacoemulsification using the active fluidic system,and 20 cases(20 eyes)in the control group were treated with phacoemulsification using gravity fluidic system.Records were kept of the intraoperative color Doppler energy(CDE),the patient’s best corrected visual acuity(BCVA),corneal endothelial condition[corneal endothelial cell density(ECD),central corneal thickness(CCT)]at 1 d,1 week,and 1 month after surgery.ITrace was used to measure the higher-order aberrations and the modulation transfer function(MTF)under higher-order aberrations when the pupil diameter was 3 mm in the natural state of the surgical eye,and the data analysis was made by one-way ANOVA.Results There was no statistically significant difference between the two groups in general data before surgery.The intraoperative CDE in the study group was smaller than that in the control group[(5.54±0.91)s vs.(7.27±1.47)s;P<0.001].The difference in BCVA between the two groups was statistically significant at 1 day,1 week,and 1 month after surgery(P<0.05).There was no significant difference in ECD between the two groups before surgery,1 day,1 week,and 1 month after surgery(P>0.05).The CCT of the study group was smaller than that of the control group at 1 day and 1 week after surgery.The total eye(pupillary diameter 3 mm)higher-order aberrations and MTF under higher-order aberrations in the study group were better than those in the control group at 1 day,1 week and 1 month after surgery,and the differences were statistically significant(P<0.05).The total higher-order aberrations of the two groups gradually approached the same level over time.Conclusion Compared with the traditional gravity fluidic system,the active fluidic system can reduce the use of color Doppler energy and reduce corneal endothelial injury during cataract phacoemulsification surgery,thereby reducing postoperative corneal edema and higher-order aberration changes,so that patients can get better postoperative vision and visual quality.