超声乳化斜面向下劈核技术在硬核白内障手术中的疗效评价

Long-term Curative Effect Evaluation of Phacoemulsification Oblique Face-down Nucleus Chopping Technique in Hard Nucleus Cataract Surgery

目的应用超声能量的功效学等评价指标,与常规超声乳化劈核技术进行比较,观察超声乳化斜面向下劈核技术(drill)治疗硬核白内障的临床疗效。方法选择2018年7月—2020年6月在昆仑朝聚眼科医院住院的单眼硬核白内障患者60例(60只眼),晶状体核Ⅳ级以上(Emery分级法)。其中将接受drill劈核技术的30例(30只眼)患者设为研究组,选择同时期接受常规超声乳化劈核技术的30例(30只眼)患者作为常规组。记录并观察两组的术中超声能量和时间,计算术中超声乳化能量合成值,观察术后6个月眼压、最佳矫正视力、角膜内皮计数及角膜内皮中正六边形细胞比率等。结果术后6个月两组最佳矫正视力及眼压差异无统计学意义(P>0.05);研究组术中超声乳化能量合成值为1026.45±106.67,常规组术中超声乳化能量合成值为1291.78±131.34,高于研究组,差异有统计学意义(P<0.05);研究组和常规组角膜内皮细胞分别较术前下降(15.32±3.14)%、(21.26±4.28)%,差异具有统计学意义(P<0.05);术后6个月研究组和常规组角膜内皮中正六边形细胞比率分别较术前下降(12.11±5.32)%、(25.60±3.79)%,差异具有统计学意义(P<0.05)。结论对于Ⅳ级及以上的硬核白内障患者,drill劈核技术能够有效降低超声能量,减少角膜内皮的缺失,提高手术的安全性。

Objective Compared with conventional phacoemulsification nucleus chopping technique,we adopted some efficiency indexes of ultrasonic energy and evaluated the clinical efficacy of phacoemulsification oblique facedown nucleus chopping technique in the treatment of hard nuclear cataract.Methods Sixty patients(60 eyes)with monocular hard nucleus cataract who were hospitalized in our hospital from July 2018 to June 2020,with lens nucleus grade IV and above(Emery classification method),were selected.Among them,30 eyes were selected as the drill chopping technique group,and 30 eyes in the same period that received the conventional phacoemulsification nuclear chopping technique were selected as controls.The intraoperative ultrasound energy and time were recorded and observed.The intraoperative phacoemulsification energy synthesis value,the intraocular pressure,best corrected visual acuity,corneal endothelial count and the ratio of regular hexagonal cells in the corneal endothelium were calculated and observed at 6 months after surgery.Results There was no significant difference in best corrected visual acuity and intraocular pressure between the two groups at 6 months after surgery(P>0.05).The energy synthesis value of phacoemulsification in the drill group was 1026.45±106.67,which was significantly lower than conventional group of 1291.78±131.34(P<0.05).The corneal endothelial cells of the two groups after operation were significantly decreased by(15.32±3.14)%and(21.26±4.28)%than those before the operation,respectively(P<0.05).The ratio of regular hexagonal cells in the corneal endothelium in two groups after operation were significantly decreased by(12.11±5.32)%and(25.60±3.79)%,respectively(P<0.05).Conclusion For hard-core cataract patients of grade IV and above,drill chopping technology can effectively lower ultrasound energy,reduce the loss of corneal endothelium,and improve the safety of surgery.