同軸1.8mm微切口白內(nèi)障超聲乳化吸除術(shù)的臨床研究

惠　娜，喻　磊，王從毅，楊新光

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·臨床論著·

同軸1.8mm微切口白內(nèi)障超聲乳化吸除術(shù)的臨床研究

惠娜，喻磊，王從毅，楊新光

Abstract

?AIM: To observe and compare clinical effects of coaxial 1.8mm microincision phacoemulsification and 3.2mm small incision phacoemulsification.

?METHODS: A total of 117 eyes of 85 patients with age-related cataract in our hospital were divided randomly into two groups: 43 patients (59 eyes) in the coaxial 1.8 mm microincision cataract surgery group (C-MICS),42 patients (58 eyes) in the coaxial 3.2 mm traditional small incision cataract surgery group (C-SICS).A total of 117 eyes were received phacoemulsification with intraocular lens implantation.Uncorrected visual acuity was recorded preoperatively and postoperatively at 1,7,30 and 90d.The effective phacoemulsification time and average ultrasound energy were recorded in surgery.Corneal endothelial cell and corneal topography were recorded preoperatively and postoperatively at 90 d.

?RESULTS: Uncorrected visual acuity (logMAR) was no overall statistical significance difference between C-MICS group and C-SICS group (P>0.05),but was significant statistical difference in different time-point within both groups(P<0.05).Uncorrected visual acuity in different time-point had nothing to do with corneal wound size in cataract surgery(P>0.05).On the 1 day after surgery,uncorrected visual acuity was 0.16±0.11 in C-MICS group and 0.22±0.18 in C-SICS group(P<0.05).AVE was (7.00±2.72)% in C-MICS group and (6.16±3.16)% in C-SICS group (P>0.05).EPT was (3.09±1.61)s in C-MICS group and (3.20±1.92)s in C-SICS group (P>0.05).At 90 d after surgery,corneal endothelial cell loss percentage was (5.81±2.28)% in C-MICS group and (5.69±2.38)% in C-SICS group (P>0.05),SIA was (0.35±0.11) Din C-MICS group and (0.61±0.13) D in C-SICS group (P<0.05).

?CONCLUSION: Compared with coaxial 3.2mm traditional small incision cataract surgery,1.8mm coaxial microincision cataract surgery can get earlier visual rehabilitation and significantly reduce SIA.The coaxial 1.8mm microincision cataract surgery is safe,effective and deserves further clinical applications.

目的：用前瞻性隨機方法，對照研究1.8mm和3.2mm透明角膜切口同軸白內(nèi)障超聲乳化吸除術(shù)并人工晶狀體植入的臨床療效。

方法：選取2012-12/2014-12在西安市第四醫(yī)院眼科進行白內(nèi)障超聲乳化吸除人工晶狀體植入術(shù)的年齡相關(guān)性白內(nèi)障患者85例117眼，將患者按隨機數(shù)字表法分為兩組。微切口組43例59眼，行1.8mm同軸白內(nèi)障超聲乳化吸除術(shù)；小切口組42例58眼，行3.2mm同軸白內(nèi)障超聲乳化吸除術(shù)。術(shù)中分別記錄平均超聲能量(average ultrasound energy，AVE)和有效超聲時間(effective phacoemulsification time，EPT)，術(shù)前、術(shù)后1、7、30和90d分別進行裸眼LogMAR視力檢查。術(shù)前、術(shù)后90d分別檢查角膜內(nèi)皮細胞密度和角膜地形圖。比較兩組患者術(shù)中AVE和EPT、術(shù)后裸眼LogMAR視力和術(shù)后90d角膜內(nèi)皮細胞丟失率和手術(shù)源性散光的差異。

結(jié)果：兩組患者間視力的整體差異無統(tǒng)計學(xué)意義(F=2.222，P=0.139)。兩組內(nèi)不同時間點的視力差異有統(tǒng)計學(xué)意義(F=231.968，P=0.000)。不同長度角膜切口與不同時間點的視力未見交互作用(F=0.666，P=0.428)。術(shù)后1d微切口組的裸眼LogMAR視力為0.16±0.11，小切口組的裸眼LogMAR視力為0.22±0.18，兩組比較差異有統(tǒng)計學(xué)意義(P<0.05)，余時間點兩組間視力差異無統(tǒng)計學(xué)意義(P>0.05)。微切口組和小切口組術(shù)中AVE分別為(7.00±2.72)%和(6.16±3.16)%，EPT分別為3.09±1.61s和3.20±1.92s，兩組間差異均無統(tǒng)計學(xué)意義(P>0.05)。術(shù)后90d微切口組和小切口組角膜內(nèi)皮細胞丟失率分別為(5.81±2.28)%和(5.69±2.38)%，兩組間差異無統(tǒng)計學(xué)意義(P>0.05)。術(shù)后90d微切口組和小切口組SIA分別為0.35±0.11D和0.61±0.13D，兩組間差異有統(tǒng)計學(xué)意義(P<0.05)。

結(jié)論：與3.2mm同軸小切口白內(nèi)障超聲乳化吸除術(shù)比較，1.8mm同軸微切口術(shù)具有術(shù)后早期視力恢復(fù)快、術(shù)后晚期手術(shù)源性散光小等優(yōu)點，而且不增加能量的使用，不加重角膜內(nèi)皮細胞的損傷。