飞秒激光辅助的白内障手术与常规白内障超声乳化手术治疗软核白内障的临床疗效比较

Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for soft nucleus cataract

目的比较飞秒激光辅助的白内障手术和常规白内障超声乳化手术在软核白内障病人中的临床疗效。方法根据Emery-Little白内障晶状体核硬度分级,回顾性纳入2018年6月至2019年3月海南医学院第一附属医院晶状体核硬度为Ⅰ-Ⅱ级核的病人,完整完成随访者20例共20只眼,按术式分为飞秒组和常规组,均为10例10眼,分别行飞秒激光辅助的白内障超声乳化手术和常规白内障超声乳化手术。术前和术后1 d、1周、1个月和3个月分别评价视力、中央角膜厚度和角膜内皮细胞计数。结果飞秒组的平均超声乳化能量[常规组:(15.89±2.75)%,飞秒组:(12.80±1.79)%]和有效超声乳化时间[常规组:(18.94±2.43)s,飞秒组:(12.02±0.92)s]均比常规组的低,差异有统计学意义(P=0.008,P<0.001)。两组病人在术后3月的视力恢复上差异无统计学意义(P=0.423)。两组病人术后早期[术后1 d:(579.61±8.19)μm、术后1周:(565.28±7.72)μm]中央角膜厚度均低于同随访点的常规组[术后1 d:(592.41±7.83)μm、术后1周:(577.74±15.06)μm](P<0.05)。术后1月[飞秒组:(555.05±10.68)μm、常规组:(561.75±5.65)μm]、3月[飞秒组:(549.25±7.37)μm、常规组:(553.02±4.93)μm],两组病人的中央角膜厚度均呈下降趋势,但差异无统计学意义。两组病人的角膜内皮细胞计数均呈逐渐下降趋势。术后早期飞秒组[术后1 d:(2533.40±178.47)mm^2、术后1周:(2548.00±152.78)mm^2、术后1月:(2522.10±128.88)mm^2]的角膜内皮细胞计数均高于同时期的常规组[术后1 d:(2359.10±110.71)mm^2、术后1周:(2403.50±114.00)mm^2、术后1月:(2389.30±104.69)mm2],且差异有统计学意义(P=0.044,P=0.028,P=0.021)。术后3月飞秒组(2573.00±193.81)mm^2的角膜内皮细胞计数与同时期的常规组(2443.30±182.64)mm^2组间差异无统计学意义(P=0.141)。结论飞秒激光辅助的软核白内障手术与常规白内障超声乳化手术相比,具有一致的临床疗效,且安全性更高。

Objective To compare the clinical efficacies of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in soft nucleus cataract patients.Methods According to Emery-Little classification of nucleus hardness of cataract,patients with nucleus hardness of grade I-II,who underwent surgery at The First Affiliated Hospital of Hainan Medical University from June 2018 to March 2019,were retrospectively included in the study.Twenty cases(20 eyes)with complete follow-up were assigned into femtosecond group(10 cases,10 eyes)and conventional group(10 cases,10 eyes)according to surgical method.Femtosecond laser-assisted cataract phacoemulsification and conventional cataract phacoemulsification were performed respectively.Visual acuity,central corneal thickness and corneal endothelial cell count were evaluated before operation and 1 day,1 week,1 month and 3 months after operation.Results The average phacoemulsification energy[(12.80±1.79)%vs.(15.89±2.75)%]and the effective phacoemulsification time[(12.02±0.92)s vs.(18.94±2.43)s]in the femtosecond group were significantly lower than those in the conventional group(P=0.008,P<0.001).There was no significant difference in visual acuity between the two groups in 3 months(P=0.423).The central corneal thickness of the femtosecond group postoperatively was lower than that of the conventional group at the same follow-up point[1 day after operation:(579.61±8.19)μm vs.(592.41±7.83)μm;1 week after operation:(565.28±7.72)μm vs.(577.74±15.06)μm](P<0.05).One month and 3 months after operation,the central corneal thickness of the two groups showed a downward trend,but there was no significant difference between femtosecond group and conventional group[1 month after operation:(555.05±10.68)μm vs.(561.75±5.65)μm;3 months after operation:(549.25±7.37)μm vs.(553.02±4.93)μm].The number of corneal endothelial cells in both groups decreased gradually.The number of corneal endothelial cells in the early postoperative period in femtosecond group[1 day after operation:(2533.40±178.47)mm^2;1 week after operation:(2548.00±152.78)mm^2;and 1 month after operation:(2522.10±128.88)mm^2]was higher than that in the conventional group[1 day after operation:(2359.10±110.71)mm^2;1 week after operation:(2403.50±114.00)mm^2;and 1 month after operation:(2389.30±104.69)mm^2],and the difference was statistically significant(P=0.044,P=0.028,P=0.021,respectively).There was no significant difference in the corneal endothelial cell count between the femtosecond group[(2573.00±193.81)mm^2]and the conventional group[(2443.30±182.64)mm^2]during the same period(P=0.141).Conclusion Compared with conventional phacoemulsification,femtosecond laser-assisted phacoemulsification in soft nucleus cataract has the same clinical efficacy and higher safety.