西藏地区藏族白内障患者两种手术方式的对比

Comparative analysis of the efficacy of small incision cataract surgery and phacoemulsification for the treatment of tibetan cataract patients

摘要:

目的：比较分析西藏高原地区白内障患者行小切口非超声乳化与超声乳化两种不同手术方式的术后视力、术中及术后并发症情况。

方法：收集2014-10/2015-01西藏自治区藏医院眼科收治的白内障患者413例413眼，随机分成白内障超声乳化吸除联合人工晶状体植入术(超乳组)200例200眼，小切口非超声乳化白内障摘除联合人工晶状体植入术(小切口组)213例213眼。分别比较两组术后1、5d裸眼视力、术中及术后并发症情况。

结果：术后1、5d两组患者裸眼视力≥0.5分别为小切口组150眼(70.4%)，196眼(92.0%)，超声乳化组156眼(78.0%)，185眼(92.5%)； 与小切口组相比，超乳组术后1d与术前视力差值有统计学意义(P<0.05)； 小切口组和超乳组术后5d与术后1d裸眼视力差值比较差别无统计学意义(P=0.33)。核硬度Ⅰ级白内障患者，术后超乳组视力≥0.5患眼数与小切口组比较无统计学差异(P>0.05)； 核硬度Ⅱ级白内障患者，术后超乳组视力≥0.5患眼数明显多于小切口组(P<0.01)； 核硬度Ⅲ级白内障患者，术后超乳组视力≥0.5患眼数明显多于小切口组(P<0.01)； 核硬度Ⅳ级白内障患者，术后超乳组视力≥0.5患眼数与小切口组比较无统计学差异(P>0.05)； 核硬度Ⅴ级白内障患者，术后超乳组视力≥0.5患眼数与小切口组比较无统计学差异(P>0.05)。小切口组与超乳组患者角膜水肿者比较无统计学差异(P>0.05)。小切口组与超乳组患者虹膜反应比较无统计学差异(P>0.05)。

结论：本研究表明老年性白内障仍是西藏地区白内障患病的主要病因之一，目前手术治疗白内障仍是最有效的治疗方式。超声乳化组核硬Ⅱ、Ⅲ级的白内障患者术后1d 视力提高较小切口非超声乳化白内障摘除术组显著，而核硬度Ⅰ、Ⅳ、Ⅴ级无统计学差别。两组在术后5d视力、角膜水肿、虹膜反应等并发症无明显差异，因此，在没有条件进行超声乳化手术的情况下，小切口非超声乳化手术同样可以达到相似的治疗效果。

Abstract:

AIM:To analyze the postoperative visual acuity, and preoperative and postoperative complications in cataract patients in Tibet Plateau area who received small incision cataract extraction without phacoemulsification as compared to in those who received phacoemulsification.

METHODS:Four hundred and thirteen cataract patients admitted to ophthalmology departments in traditional Tibetan medicine hospital in Tibet Autonomic Region from October 2014 to January 2015 were collected. They were randomized into the group(200 patients with 200 eyes)receiving phacoemulsification combined with intraocular lens implantation as Phaco group and the group(213 patients with 213 eyes)receiving small incision cataract extraction combined with intraocular lens implantation as small incision group. The two groups were compared for uncorrected visual acuity at 1 and 5d postoperatively, and the preoperative and postoperative complications.

RESULTS:At 1 and 5d postoperatively, there were 150 eyes(70.4%)and 196 eyes(92.0%)with visual acuity ≥0.5 in the small incision group, respectively. There were 156 eyes(78.0%)and 185 eyes(92.5%)in the Phaco group. The difference value of visual acuity before and at 1d after the operation of Phaco group was higher than that of small incision group(P<0.05); while the difference value of visual acuity between 5d and 1d after the operation showed no different between Phaco group and small incision group(P=0.33). According to Emery Standard, the number of eyes with visual acuity ≥0.5 showed no statistically significant differences between two groups in the patients with nuclear-grade I, Ⅳ and Ⅴ(P>0.05); however, it was statistically significant differences between two groups in the patients with nuclear-gradeⅡ and Ⅲ(P<0.01). But there was no statistical significance for corneal edema or iris reaction between the two groups(P>0.05).

CONCLUSION:This study showed that age-relative cataract is still one of the most common pathogenesis in Tibet. Surgery is the only option for the best treatment effect so far. On postoperative 1d, the visual acuity of the patients with nuclear-gradeⅡ and Ⅲ in the Phaco group improved more than those in the small incision group. While, there was no significant difference in patients with nuclear-grade I, Ⅳ and Ⅴ. No differences were found on corneal edema, iris reaction or other complications. Therefore, small incision cataract extraction can achieve similar effect in the absence of condition for phacoemulsification.