方法：选取2012-12/2014-12在西安市第四医院眼科进行白内障超声乳化吸除人工晶状体植入术的年龄相关性白内障患者85例117眼，将患者按随机数字表法分为两组。微切口组43例59眼，行1.8mm同轴白内障超声乳化吸除术； 小切口组42例58眼，行3.2mm同轴白内障超声乳化吸除术。术中分别记录平均超声能量(average ultrasound energy，AVE)和有效超声时间(effective phacoemulsification time，EPT)，术前、术后1、7、30和90d分别进行裸眼LogMAR视力检查。术前、术后90d分别检查角膜内皮细胞密度和角膜地形图。比较两组患者术中AVE和EPT、术后裸眼LogMAR视力和术后90d角膜内皮细胞丢失率和手术源性散光的差异。

结果：两组患者间视力的整体差异无统计学意义(F=2.222，P=0.139)。两组内不同时间点的视力差异有统计学意义(F=231.968，P=0.000)。不同长度角膜切口与不同时间点的视力未见交互作用(F=0.666，P=0.428)。术后1d微切口组的裸眼LogMAR视力为0.16±0.11，小切口组的裸眼LogMAR视力为0.22±0.18，两组比较差异有统计学意义(P<0.05)，余时间点两组间视力差异无统计学意义(P>0.05)。微切口组和小切口组术中AVE分别为(7.00±2.72)%和(6.16±3.16)%，EPT分别为3.09±1.61s和3.20±1.92s，两组间差异均无统计学意义(P>0.05)。术后90d微切口组和小切口组角膜内皮细胞丢失率分别为(5.81±2.28)%和(5.69±2.38)%，两组间差异无统计学意义(P>0.05)。术后90d微切口组和小切口组SIA分别为0.35±0.11D和0.61±0.13D，两组间差异有统计学意义(P<0.05)。

结论：与3.2mm同轴小切口白内障超声乳化吸除术比较，1.8mm同轴微切口术具有术后早期视力恢复快、术后晚期手术源性散光小等优点，而且不增加能量的使用，不加重角膜内皮细胞的损伤。

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.