飞秒激光辅助超声乳化白内障吸除术治疗老年性白内障疗效观察

Effect of femtosecond laser-assisted phacoemulsification in the treatment of senile cataract

目的探讨飞秒激光辅助超声乳化白内障吸除术治疗老年性白内障的临床效果。方法选择2018年2月至2019年2月河北省眼科医院收治的104例老年性白内障患者为研究对象,根据手术方法分为观察组(52例86眼)和对照组(52例78眼)。对照组患者给予传统超声乳化白内障吸除术治疗,观察组患者给予飞秒激光辅助超声乳化白内障吸除术。分别于术前及术后1、4、12周检测2组患者的散光度数和裸眼视力,2组患者分别于术前和术后12周应用非接触式角膜内皮镜进行检查,观察患者角膜内皮细胞密度、六角形细胞比例及角膜内皮细胞变异系数,并观察术后并发症。结果2组患者术前角膜散光度数和裸眼视力比较差异无统计学意义(P>0.05)。与术前比较,术后1、4、12周2组患者角膜散光度数显著降低,裸眼视力显著提高(P<0.05);术后1、4、12周,观察组患者角膜散光度数低于对照组,裸眼视力显著高于对照组(P<0.05)。2组患者术前角膜内皮细胞密度、六角形细胞比例和角膜内皮细胞变异系数比较差异无统计学意义(P>0.05);与术前比较,2组患者术后12周角膜内皮细胞密度、六角形细胞比例显著降低,角膜内皮细胞变异系数显著升高(P<0.05);术后12周,观察组患者角膜内皮细胞密度、六角形细胞比例显著低于对照组,角膜内皮细胞变异系数显著小于对照组(P<0.05)。观察组和对照组患者术后角膜水肿发生率分别为5.49%(5/86)、17.95%(14/78),观察组患者术后角膜水肿发生率显著低于对照组(χ2=4.648,P<0.05)。2组患者无其他相关严重并发症发生。结论飞秒激光辅助超声乳化手术可以显著减少超声能量对角膜的损害,有助于提高患者的裸眼视力,改善患者角膜散光度。

Objective To investigate the clinical effect of femtosecond laser-assisted phacoemulsification in the treatment of senile cataract.Methods A total of 104 patients with senile cataract admitted to Hebei Eye Hospital from February 2018 to February 2019 were selected as the research subjects,and they were divided into the observation group(52 cases,86 eyes)and control group(52 cases,78 eyes)according to the operation methods.The patients in the control group were treated with conventional phacoemulsification,while the patients in the observation group were treated with femtosecond laser-assisted phacoemulsification.The astigmatism and naked vision of the patients in the two groups were detected before and 1,4 and 12 weeks after operation.The density and the coefficient of variation of corneal endothelial cells and the proportion of hexagonal cells were observed by non-contact corneal endothelioscopy before and 12 weeks after operation.The postoperative complications were observed.Results There was no significant difference in the corneal astigmatism and naked vision between the two groups before operation(P>0.05).Compared with before operation,the corneal astigmatism significantly decreased and the naked vision significantly improved at 1,4 and 12 weeks after operation in the two groups(P<0.05).At 1,4 and 12 weeks after operation,the corneal astigmatism of the patients in the observation group was lower than that in the control group,and the naked vision in the observation group was higher than that in the control group(P<0.05).There was no significant difference in the density and the coefficient of variation of corneal endothelial cells and the proportion of hexagonal cells between the two groups before operation(P>0.05).Compared with before operation,the density of corneal endothelial cells and the proportion of hexagonal cells decreased,and the coefficient of variation of corneal endothelial cells increased at 12 weeks after operation in the two groups(P<0.05).At 12 weeks after operation,the density of corneal endothelial cells and the proportion of hexagonal cells in the observation group were lower than those in the control group,and the coefficient of variation of corneal endothelial cells in the observation group was less than that in the control group(P<0.05).The incidence of postoperative corneal edema in the observation group and the control group was 5.49%(5/86)and 17.95%(14/78),respectively.The incidence of postoperative corneal edema in the observation group was lower than that in the control group(χ2=4.648,P<0.05).There were no other serious complications in the two groups.Conclusion The femtosecond laser-assisted phacoemulsification can significantly reduce the damage of ultrasonic energy on the corneal,which is helpful to improve the naked vision and corneal astigmatism.