吲哚菁绿辅助晶状体超声乳化联合人工晶状体植入术治疗白内障合并角膜斑翳患者的临床效果

Indocyanine green assisted lens phacoemulsification combined with intraocular lens implantation in the treatment of cataract with corneal macula

目的探讨吲哚菁绿辅助晶状体超声乳化术联合人工晶状体植入术治疗白内障合并角膜斑翳患者的临床效果。方法选取湖北医药学院附属东风医院收治的52例(76眼)白内障合并角膜斑翳患者作为研究对象,随机分为常规组和吲哚菁绿组。常规组患者24例(35眼),均行晶状体超声乳化术联合人工晶状体植入术;吲哚菁绿组患者28例(41眼),采用吲哚菁绿进行前囊膜染色,然后行晶状体超声乳化术联合人工晶状体植入术。记录两组患者术前及术后1 d、7 d最佳矫正视力、角膜水肿分级情况,手术时间,术前及术后1个月中央角膜内皮细胞计数以及术中、术后并发症发生情况。结果术前及术后7 d,两组患者最佳矫正视力比较,差异均无统计学意义(均为P>0.05);术后1 d,吲哚菁绿组患者最佳矫正视力明显高于常规组,差异有统计学意义(P<0.05)。两组患者术后1 d、7 d最佳矫正视力均高于术前,差异均有统计学意义(均为P<0.05);术后7 d最佳矫正视力高于术后1 d,差异有统计学意义(P<0.05)。两组患者术后7 d角膜水肿均较术后1 d明显好转,角膜水肿分级均降低(均为P<0.05)。术后1 d,吲哚菁绿组角膜水肿分级较常规组低,差异有统计学意义(P<0.05)。常规组患者手术时间为(17.25±5.38)s,吲哚菁绿组为(16.34±1.62)s,两组比较差异无统计学意义(t=0.966,P=0.340)。术后常规组患者角膜中央内皮细胞计数为(1740.51±484.27)个·mm^(-2),吲哚菁绿组为(1996.73±475.83)个·mm^(-2),两组比较差异有统计学意义(t=-2.321,P=0.023);两组患者组内中央角膜内皮细胞计数比较,术后均低于术前,差异均有统计学意义(均为P=0.000)。术中及术后并发症发生眼数,吲哚菁绿组较常规组减少。结论对于白内障合并角膜斑翳患者,在晶状体超声乳化术联合人工晶状体植入术中应用吲哚菁绿行前囊膜染色,可减轻角膜损伤、减少并发症,使患者术后视力恢复更快,并且不会延长手术时间。

Objective To investigate the clinical effect of indocyanine green assisted lens phacoemulsification combined with intraocular lens implantation in the treatment of cataract with corneal macula.Methods A total of 52 patients(76 eyes)of cataract with corneal macula in the Affiliated Dongfeng Hospital,Hubei University of Medicine were randomly divided into routine group and indocyanine green group.In routine group,24 patients(35 eyes)underwent phacoemulsification combined with intraocular lens implantation.Indocyanine green group of 28 patients(41 eyes),the anterior capsule was stained with indocyanine green,and then lens phacoemulsification combined with intraocular lens implantation was performed.The best corrected visual acuity,grade of corneal edema,operative time,and central corneal endothelial cell counts before and 1 month after surgery,and intraoperative and postoperative complications in both groups were recorded.Results Before and 7 days after surgery,there was no significant difference in the best corrected visual acuity between 2 groups(all P>0.05).On day 1 after surgery,the best corrected visual acuity in the indocyanine green group was significantly higher than that in the routine group,with statistical significance(P<0.05).The best corrected visual acuity at 1 day and 7 days after surgery was higher in 2 groups than before surgery,and the differences were statistically significant(all P<0.05).The best corrected visual acuity 7 days after surgery was higher than that 1 day after surgery,and the difference was statistically significant(P<0.05).Corneal edema at 7 days after surgery was significantly improved in both groups compared with 1 day after surgery,and the grade of corneal edema was decreased in both groups(all P<0.05).On 1 day after surgery,the grade of corneal edema in the indocyanine green group was lower than that in the routine group,and the difference was statistically significant(P<0.05).The operation time was(17.25±5.38)s in the routine group and(16.34±1.62)s in the indocyanine green group.There was no significant difference between the two groups(t=0.966,P=0.340).The central corneal endothelial cell count was(1740.51±484.27)cells·mm^(-2) in the routine group and(1996.73±475.83)cells·mm^(-2) in the indocyanine green group,and the difference between the two groups was statistically significant(t=-2.321,P=0.023).The number of central corneal endothelial cells in both groups was lower after surgery than before surgery,and the differences were statistically significant(all P=0.000).The number of intraoperative and postoperative complications in the indocyanine green group was less than that in the routine group.Conclusion For patients with cataract combined with corneal macula,anterior capsule staining with indocyanine green during phacoemulsification combined with intraocular lens implantation can reduce corneal injury,reduce complications,and make patients recover their visual acuity faster after surgery without prolongation of operation time.