微切口预劈核超声乳化白内障吸除术治疗硬核性白内障患者的临床疗效研究

Clinical study on microincision pre-chopping phacoemulsification in patients with hard nuclear cataract

目的:研究1.8mm微切口预劈核超声乳化白内障吸除术(Phacoemulsification,Phaco)治疗硬核性白内障患者的效果。方法:选取2019年1月~2021年3月期间我院收治的84例硬核性白内障患者作为研究对象,按治疗方案不同分成实验组和对照组,各42例。对照组接受3.0 mm小切口Phaco联合折叠式晶状体植入术(Intraocular lens implantation,IOL)治疗,实验组接受1.8mm微切口预劈核Phaco联合折叠式IOL治疗。对比两组术前、术后7 d、30 d视力、眼压、中央前房深度(Anterior chamber depth,ACD)、角膜地形图散光及角膜内皮计数变化、泪液白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)水平、并发症发生率。结果:两组术后30 d视力(LogMAR值)和角膜内皮计数、两组术后7 d和30 d眼压及ACD、两组并发症总发生率均无明显差异(P>0.05),实验组术后7 d视力(LogMAR值)和术后7 d、30 d角膜地形图散光、术后7 d、30 d泪液TNF-α、IL-6水平均较对照组低(P<0.05),实验组术后7 d角膜内皮计数较对照组高(P<0.05)。结论:小切口Phaco联合折叠式IOL或微切口预劈核Phaco联合折叠式IOL治疗硬核性白内障患者均能有效改善眼压及ACD,安全性高,但前者于短期内提高视力、稳定角膜内皮计数、改变角膜地形图散光、减轻炎性反应方面更具优势。

Objective:To study the effect of 1.8mm microincision prechopping phacoemulsification(Phaco)in the treatment of patients with hard nuclear cataract.Methods:A total of 84 patients with hard nuclear cataract who were treated in our hospital from January 2019 to March 2021 were selected as the research objects,and divided into an experimental group and a control group according to different treatment plans,with 42 cases in each.The control group received 3.0mm small incision Phaco combined with Intraocular lens implantation(IOL),and the experimental group received 1.8mm microincision pre-chopping Phaco combined with foldable IOL.The visual acuity,intraocular pressure,central anterior chamber depth(ACD),corneal topography astigmatism,corneal endothelial count changes,tear interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)level,incidence of complications were compared between the two groups before surgery,at 7 d and 30 d after surgery.Results:There was no significant difference in visual acuity(LogMAR value)at 30 days after operation,the intraocular pressure,ACD and corneal endothelial count at 30 days after operation,and the total incidence of complications between the two groups(P>0.05).The visual acuity(LogMAR value)at 7 days after operation,the astigmatism of the corneal topography at 7d and 30d after operation,the levels of TNF-αand IL-6 in tears of the experimental group at 7d and 30d after operation in the experimental group was lower than those in the control group(P<0.05);the corneal endothelium count in the experimental group was higher than that in the control group 7 days after operation.Conclusion:Small incision Phaco combined with foldable IOL or microincision pre-chopping Phaco combined with foldable IOL can effectively improve intraocular pressure and ACD in patients with hard nuclear cataract,with high safety,but the former can improve visual acuity in the short term,It has more advantages in stabilizing corneal endothelial count,changing corneal topography astigmatism,and reducing inflammatory response.