不同切口白内障超声乳化术的疗效及对角膜内皮细胞的影响

Effect of phacoemulsification with different incision on corneal endothelial cells

目的:探究3.0mm切口白内障超声乳化术与1.8mm同轴微切口白内障超声乳化术治疗疗效及对角膜内皮细胞的影响。方法:选择2016-12/2018-12我院住院的78例78眼年龄相关性白内障患者作为研究对象,按照术中手术切口大小不同分为标准切口组及微切口组,每组39例39眼。标准切口组患者行3.0mm标准切口白内障超声乳化人工晶状体植入术,微切口组行1.8mm同轴微切口白内障超声乳化人工晶状体植入术,比较两组患者手术疗效及角膜内皮细胞参数。结果:标准切口组及同轴微切口组患者超声乳化时间分别为7.05±0.98、7.22±0.96s,超声乳化能量分别为(17.01±1.89)%、(16.89±1.53)%(P>0.05);与术前比较,两组患者术后裸眼视力(LogMAR)显著降低(P<0.001),散光程度加重(P<0.001),微切口组术后1d,1wk时裸眼视力及散光程度优于标准切口组(P<0.05);两组患者术后1d,1wk,1、3mo内皮细胞密度显著降低(P<0.05),角膜内皮细胞变异系数、中央角膜厚度增大,两组间各时间点比较均无差异(P>0.05);两组患者均无严重并发症,标准切口组患者1眼出现一过性高眼压,药物治疗后眼压恢复正常。结论:同轴微切口白内障超声乳化手术与标准小切口手术均对内皮细胞形态及功能有一定影响,但两者无明显差异,但同轴微切口白内障超声乳化术可缩小手术切口,降低术源性散光程度,术后恢复快,是一种相对安全的手术方式。

AIM:To investigate the curative effect of 3.0mm incision phacoemulsification and 1.8mm coaxial micro-incision phacoemulsification and the influence on corneal endothelial cells.METHODS:A total of 78 patients(78 eyes)with age-related cataract who were hospitalized in the hospital from December 2016 to December 2018 were selected as subjects.They were divided into the standard incision group and the micro-incision group with 39 cases(39 eyes)in each group.Patients in the standard incision group were treated with 3.0mm standard incision phacoemulsification and intraocular lens implantation,while the patients in the micro-incision group were treated with 1.8mm coaxial micro-incision phacoemulsification and intraocular lens implantation.The surgical outcome and corneal endothelial cell parameters were compared between the two groups.RESULTS:The phacoemulsification time of the standard incision group and the micro-incision group were(7.05±0.98)s and(7.22±0.96)s,respectively.The phacoemulsification energy was(17.01±1.89)%and(16.89±1.53)%,respectively(P>0.05).The LogMAR of naked eyes of both groups decreased significantly at 1d,1wk and 1mo after surgery(P<0.001),while the degree of astigmatism increased(P<0.001).The naked vision and astigmatism of the micro-incision group were better than those of the standard incision group at 1d and 1wk after surgery(P<0.05).Endothelial cell density was significantly decreased at 1d,1wk and 1mo after surgery(P<0.05).The coefficient of variation of corneal endothelial cells and the thickness of central cornea increased.There was no significant difference between the standard incision group and the micro-incision group at each time poilt(P>0.05).There were no severe complications in either group.There was one patient with transient high intraocular pressure in the standard incision group,and the intraocular pressure returned to normal after drug treatment.CONCLUSION:Both coaxial micro-incision phacoemulsification and standard small incision surgery have certain effects on the morphology and function of endothelial cells.Besides,there is no significant difference between them.However,coaxial micro-incision phacoemulsification can minimize the surgical incision and reduce the degree of surgically induced astigmatism,and patients can recover quickly after surgery.It is a relatively safer surgical procedure.