走罐式前后囊膜抛光联合张力环植入对超高度近视白内障术后囊袋稳定性的影响

Effects of can walking anterior and posterior capsule polishing combined with tension ring implantation on lens capsular stability after phacoemulsification for ultra-high myopia cataract

目的观察在2.0 mm同轴微切口超高度近视白内障超声乳化手术中,应用灌注抽吸系统(I/A)注吸针头对晶状体前、后囊膜进行抛光,联合囊袋张力环(CTR)植入,对术后人工晶状体(IOL)及囊袋稳定性的影响。方法本研究为前瞻性随机对照研究。2019年1月至2021年2月,接诊超高度近视白内障患者40例(80眼),年龄46~72岁,晶状体混浊分级为Ⅱ~Ⅳ级,屈光度-10 D~-24 D。在施行2.0 mm同轴微切口超声乳化手术时,用抛硬币法随机对一眼应用I/A注吸针头对晶状体前后囊膜进行360°全方位走罐式抛光并植入CTR作为试验组(40眼),对侧眼则不抛光不植入CTR作为对照组(40眼)。双眼手术时间间隔1周以内。门诊随访记录术后1周、1个月、3个月、6个月的前囊口大小、有效人工晶状体位置(ELP)、IOL偏心量及后发性白内障(PCO)情况。采用两独立样本t检验和Fisher确切概率检验比较两组间的差异,P<0.05为差异有统计学意义。结果随访期间,试验组的前囊口面积、IOL偏心量和ELP无明显变化,而对照组的前囊口面积随着时间延长逐渐缩小,IOL偏心量逐渐变大,ELP逐渐变小。两组间比较,术后1周各观察指标差异均无统计学意义(P>0.05),但ELP首先表现出差异趋势(P<0.01);术后1、3、6个月,对照组的ELP均明显小于试验组,差异有统计学意义(P<0.05);两组的前囊口面积和IOL偏心量在术后1、3个月时差异无统计学意义(P>0.05),在术后6个月时差异有统计学意义(P<0.05);在PCO方面,术后1、3、6个月,试验组PCO发生率分别为0%、2.5%、7.5%,对照组分别为5.0%、17.5%、32.5%,试验组PCO发生率明显低于对照组(P<0.05)。结论超高度近视白内障患者术后容易发生囊袋收缩,表现为IOL的不稳定性且前囊口逐渐缩小趋势,术中对其进行360°前、后囊膜抛光联合CTR植入可有效维持ELP的稳定,减少前囊口收缩程度、减少IOL偏心量及PCO的发生率。应用I/A注吸针头对晶状体前、后囊膜进行走罐式抛光,联合CTR治疗超高度近视白内障安全性好,疗效稳定。

Objective To observe the effects of polishing the anterior and posterior capsule with irrigation/aspiration(I/A)injection needle and capsular tension ring(CTR)implantation on intraocular lens(IOL)capsular stability after phacoemulsification for ultra-high myopia with 2.0 mm coaxial micro incision.Methods This is a prospective randomized controlled study.There were 40 patients(80 eyes)aged 46-72 years old with ultra-high myopia cataract.The grade of lens opacity was grade II-IV,and the diopter was-10 D--24 D.During 2.0 mm coaxial micro incision phacoemulsification,adopt coin tossing method randomly,1 eye was operated using the anterior and posterior capsule polishing 360°with I/A injection needle combined with CTR implantation as the experimental group(40 eyes),the other eye was neither polished nor CTR implantated as the control group(40 eyes).The operation interval of both eyes was less than 1 week.The size of anterior capsular orifice,effective intraocular lens position(ELP),IOL eccentricity and posterior capsular opacification(PCO)were recorded at 1 week,1,3 and 6 months after operation in outpatient clinic.Two independent sample t-test and Fisher exact probability test were used to compare the differences between the 2 groups.P<0.05 was defined significant difference.Results During the follow-up period,there were no significant change in the anterior capsule area,IOL eccentricity and ELP in the experimental group.However in the control group,the anterior capsular area decreased gradually with time,and gradually IOL eccentricity increased and ELP decreased.There was no significant difference between the 2 groups in each observation index at 1 week after operation,but it was ELP that first showed the difference tendency(P<0.01).The ELP of the control group was significantly lower than that of the experimental group at 1,3 and 6 months after operation(P<0.05).There was no significant difference in anterior capsule area and IOL eccentricity between the 2 groups at 1 and 3 months after operation(P>0.05),but there was a significant difference at 6 months(P<0.05).In terms of PCO,the incidence of PCO was 0%,2.5%and 7.5%in the experimental group and 5.0%,17.5%and 32.5%in the control group respectively at 1,3 and 6 months after operation.The incidence of PCO in the experimental group was significantly lower than that in the control group(P<0.05).Conclusion Ultra-high myopia with cataract are prone to have capsular contraction after operation,which is characterized by IOL instability and anterior capsular orifice narrowing gradually.Combined 360°anterior and posterior capsular polishing with tension ring implantation in operation can effectively maintain the stability of ELP,reduce the degree of contraction of anterior capsular orifice,reduce the eccentricity of IOL and the incidence of PCO.Polishing the anterior and posterior capsule with I/A injection needle combined with CTR implantation,is safe and effective for patients with ultra-high myopia cataract.