微切口超声乳化术后角膜生物力学变化

Corneal biomechanical properties changes after microincision phacoemulsification

目的比较2.2 mm微切口与3.0 mm标准切口的超声乳化白内障术后角膜生物力学的变化。方法前瞻性随机对照研究。将洛阳市中心医院2017年8月至2018年3月年龄相关性白内障76例(76眼)随机分成两组:研究组,2.2 mm微切口组,38例;对照组,3.0 mm标准切口组,38例。术后随访4周,比较两组角膜生物力学指标。结果术后1 d,两组的角膜滞后性均较术前降低,差异有统计学意义(研究组:t=2.67,P=0.009;对照组:t=4.18,P<0.001)。研究组角膜滞后性在术后1周恢复至术前水平(t=1.56,P=0.123),而对照组术后2周恢复至术前水平(t=0.55,P=0.588);术前和术后角膜阻力因子相比无明显改变(研究组:t=0.15,P=0.880;对照组:t=0.57,P=0.569)。研究组术后1 d角膜补偿眼压和Goldman相关眼压升高(t=-3.25,P=0.002;t=-3.45,P=0.001),术后1周恢复至术前水平。对照组术后1 d和1周角膜补偿眼压和Goldman相关眼压升高,术后2周恢复至术前水平。结论2.2 mm微切口白内障手术和3.0 mm标准切口手术均会导致角膜生物力学特征改变。但微切口白内障手术术后恢复较快。

Objective To compare the changes in corneal biomechanics measured by ocular response analyzer(ORA)after 2.2 mm microincision and 3.0 mm standard incision phacoemulsification.Methods This was a randomized controlled study.A total of 76 eyes of 76 cases with age-related cataract from Aug.2017 to Mar.2018 in Luoyang Central Hospital were included and all cases were randomly divided into two groups:38 cases in the study group with 2.2 mm microincision,and 38 cases in the control group with 3.0 mm standard incision.The follow-up time was 4 weeks.All parameters of the corneal biomechanical properties of two groups were compared.Results Corneal hysteresis decreased at 1 day after operation in both groups(Study group:t=2.67,P=0.009;Control group:t=4.18,P<0.001).The corneal hysteresis returned to the preoperative level at 1 week in the study group(t=1.56,P=0.123),and which returned to normal at 2 weeks in the control group(t=0.55,P=0.588);there was no significant change in corneal resistance factor values(Study group:t=0.15,P=0.880;Control group:t=0.57,P=0.569).In the study group,mean corneal-compensated intraocular pressure and Goldmann-correlated intraocular pressure increased at 1 day postoperatively(t=-3.25,P=0.002;t=-3.45,P=0.001),and which returned to preoperative level at 1 week.In the control group,corneal-compensated intraocular pressure and Goldmann-correlated intraocular pressure increased at 1 day and 1 week postoperatively,and which returned to preoperative level at 2 weeks after operation.Conclusion The 2.2 mm microincision phacoemulsification and 3.0 mm standard incision phacoemulsification can both change the corneal biomechanics.The corneal biomechanics recover faster in 2.2 mm microincision phacoemulsification.