预劈核与水平劈核方式在白内障超声乳化手术中的应用效果及对患者角膜内皮细胞损失和术后最佳矫正视力的影响

Application effect of pre splitting and horizontal splitting in cataract phacoemulsification and its effects on corneal endothelial cell loss and postoperative best corrected visual acuity

目的探讨预劈核与水平劈核方式在白内障超声乳化手术中的应用效果及对患者角膜内皮细胞损失及术后最佳矫正视力(BCVA)的影响。方法选取2020年10月至2021年10月于湘雅常德医院接受白内障超声乳化手术治疗的100例白内障患者作为研究对象,随机分为对照组与观察组,每组50例。对照组术中实施水平劈核治疗,观察组术中实施预劈核治疗。比较两组角膜内皮细胞参数、BCVA、角膜水肿分级、超声能量参数及术后并发症发生情况。结果术后,两组细胞数量均少于术前,但观察组角膜内皮细胞数量多于对照组,观察组细胞丢失率低于对照组,差异有统计学意义(P<0.05)。术前、术后1周,两组BCVA比较差异无统计学意义;术后1 d,观察组BCVA高于对照组,差异有统计学意义(P<0.05)。术后,观察组角膜轻度水肿、中重度水肿发生率均低于对照组,差异有统计学意义(P<0.05)。术后,观察组超声乳化时间短于对照组,平均超声能量、累积释放能量参数(CDE)均低于对照组,差异有统计学意义(P<0.05)。两组术中、术后均无严重并发症发生。结论与常规水平劈核相比,在白内障患者的超声乳化手术中应用预劈核方法可简化手术步骤、缩短乳化时间,减少角膜内皮细胞损失,降低CDE,对促进患者术后均具有积极意义。

Objective To explore the application effect of pre splitting and horizontal splitting in cataract phacoemulsification and its effect on corneal endothelial cell loss and postoperative best corrected visual acuity(BCVA).Methods 100 patients with cataract who underwent phacoemulsification in Xiangya Changde Hospital from October 2020 to October 2021 were selected as the study subjects,they were random divided into the control group and the observation group,with 50 cases in each group.The control group received horizontal splitting during the operation,and the observation group received pre splitting during the operation.The corneal endothelial cell parameters,BCVA,corneal edema grading,ultrasound energy parameters and postoperative complications were compared between the two groups.Results After operation,the number of cells of the two groups was less than that before operation,but the number of corneal endothelial cells in the observation group was more than that in the control group,and the cell loss rate in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in BCVA between the two groups before and 1 week after operation;1 d after operation,the BCVA in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).After operation,the incidence of mild corneal edema and moderate to severe corneal edema in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).After operation,the ultrasonic emulsification time in the observation group was shorter than that in the control group,and the average ultrasonic energy and cumulative dissipated energy(CDE)were lower than those in the control group,the differences were statistically significant(P<0.05).No serious complications occurred in the two groups during and after operation.Conclusion Compared with conventional horizontal splitting,the application of pre splitting method in phacoemulsification of cataract patients can simplify the operation steps,shorten the emulsification time,reduce the loss of corneal endothelial cells,and reduce CDE,which is of positive significance for promoting postoperative patients.