飞秒激光辅助白内障超声乳化摘除术对白内障不同硬度晶状体核患者眼表功能及角膜结构的影响

Effects of femtosecond laser assisted phacoemulsification on ocular surface function and cornea structure in cataract patients with lens nucleus of different hardness

目的探究飞秒激光辅助白内障超声乳化摘除术对白内障不同硬度晶状体核患者眼表功能及角膜结构的影响。方法选取2018年4月至2020年8月在西安爱尔古城眼科医院接受飞秒激光联合白内障超声乳化摘除术治疗的56例(56眼)白内障患者作为研究对象,依据Emery分级法将其分为软核组(32例,Emery分级Ⅱ~Ⅲ级)和硬核组(24例,Emery分级Ⅳ~Ⅴ级)。两组均给予飞秒激光辅助白内障超声乳化摘除术治疗。比较两组的超声乳化能量、超声乳化时间、平衡盐溶液灌注量、泪膜破裂时间(BUT)、眼表疾病指数(OSDI)评分、角膜内皮细胞数目及变异系数、裸眼视力(UCVA)及最佳矫正视力(BCVA)。结果软核组的超声乳化能量及平衡盐溶液灌注量低于硬核组,超声乳化时间短于硬核组(P<0.05)。术后30 d,两组的BUT均缩短,OSDI评分均降低(P<0.05);软核组的BUT差值小于硬核组,OSDI评分差值大于硬核组(P<0.05)。术后30 d,两组的角膜内皮细胞数目均减少,角膜内皮细胞变异系数均增大(P<0.05);软核组的角膜内皮细胞数目及角膜内皮细胞变异系数差值小于硬核组(P<0.05)。术前及术后3、6个月,两组的UCVA、BCVA比较,差异无统计学意义(P>0.05);术后3、6个月,两组的UCVA、BCVA均降低(P<0.05)。结论对于软核晶状体,飞秒激光辅助白内障超声乳化摘除术治疗所需超声乳化能量少,时间短,对泪膜稳定性影响小,角膜损伤轻;对于硬核晶状体,飞秒激光辅助白内障超声乳化摘除术虽可较好恢复患者视力,但对泪膜稳定性影响大,角膜损伤重。临床中应根据晶状体核的硬度调节适宜的超声及手术参数,确保手术效果,尽可能减少术中损伤。

Objective To explore the effects of femtosecond laser assisted phacoemulsification on ocular surface function and cornea structure in cataract patients with lens nucleus of different hardness.Methods A total of 56 patients(56 eyes)with cataract who underwent femtosecond laser assisted phacoemulsification in Xi'an Aier Ancient City Eye Hospital from April 2018 to August 2020 were selected as the research objects.According to Emery classification method,the patients were divided into soft nucleus group(32 cases,Emery classificationⅡ-Ⅲ)and hard nucleus group(24 cases,Emery classificationⅣ-Ⅴ).Both groups were treated with femtosecond laser assisted phacoemulsification.The phacoemulsification energy,phacoemulsification time,balanced salt solution perfusion,breakup time of tear film(BUT),Ocular Surface Disease Index(OSDI)score,corneal endothelial cell number and coefficient of variation,uncorrected visual acuity(UCVA)and best corrected visual acuity(BCVA)were compared between the two groups.Results The phacoemulsification energy and balanced salt solution perfusion in the soft nucleus group were lower than those in the hard nucleus group,and the phacoemulsification time was shorter than that in the hard nucleus group(P<0.05).At 30 d after operation,the BUT of the two groups shortened,and OSDI score decreased(P<0.05);the difference of BUT in the soft nucleus group was smaller than that in the hard nucleus group,and the difference of OSDI score was greater than that in the hard nucleus group(P<0.05).At 30 d after operation,the corneal endothelial cell number in both groups decreased,and the corneal endothelial cell coefficient of variation increased(P<0.05);the differences of corneal endothelial cell number and corneal endothelial cell coefficient of variation in the soft nucleus group were smaller than those in the hard nucleus group(P<0.05).There were no significant differences in UCVA and BCVA between the two groups before operation,3 and 6 months after operation(P>0.05);at 3 and 6 months after operation,the UCVA and BCVA of the two groups decreased(P<0.05).Conclusion For soft nuclear lens,femtosecond laser assisted phacoemulsification requires less phacoemulsification energy and time,which has little effect on tear film stability and less corneal damage;for hard nuclear lens,femtosecond laser assisted phacoemulsification can better restore the patient's vision,but it has a great impact on the stability of the tear film and serious corneal damage.In clinical practice,appropriate ultrasound and surgical parameters should be adjusted according to the hardness of the lens nucleus to ensure the surgical effect and minimize intraoperative damage.