在流动手术车中改良角巩缘切口超乳术和手法小切口白内障囊外摘除术的比较

Comparison of improved phacoemulsification through limbus tunnel incision versus manual small-incision cataract surgery on ophthalmic operation vehicle

摘要:

目的：比较改良角巩缘切口白内障超声乳化吸除术和手法小切口白内障囊外摘除术在复明1号眼科流动手术车上的临床效果。

方法：采用非随机对照回顾性研究。选取在复明1号眼科流动手术车上行白内障手术的患者261例261眼。A组：行改良角巩缘切口白内障超声乳化吸除联合硬质人工晶状体植入术160眼，B组：行手法小切口白内障囊外摘除联合硬质人工晶状体植入术101眼，术后随访30d。对比两组患者术中手术操作时间，术后1、7、30d裸眼视力、手术源性散光(SIA)和手术并发症。

结果：改良角巩缘切口白内障超声乳化吸除术的手术操作时间较手法小切口白内障囊外摘除术短，差异有统计学意义(t=-6.419，P<0.001)。术后1、7、30d，A组裸眼视力≥0.5者分别为110眼(68.8%)、115眼(71.9%)、121眼(75.6%)，B组裸眼视力≥0.5者分别为55眼(54.5%)、63眼(62.4%)、68眼(67.3%)。术后1d，A组的视力恢复更好，差异有统计学意义(χ²=5.441，P=0.020)。两组患者术后7d和30d裸眼视力的差异无统计学意义。两组间患者术后1、7、30d SIA的整体差异无统计学意义(F=2.135，P=0.145)。两组内术后1、7、30d SIA差异有统计学意义(P<0.001)，两组不同手术方式与不同时间点的SIA 无交互作用(F=1.314，P=0.264)。两组患者术后后囊膜破裂和角膜水肿的差异无统计学意义(P>0.05)，术后1d两组患者前房反应的差异有统计学意义(χ²=5.293，P<0.05)。

结论：改良角巩缘切口白内障超声乳化吸除联合硬质人工晶状体植入术不仅手术时间短，而且术后视力恢复快，前房反应轻，适合在眼科流动手术车上使用。

Abstract:

AIM: To compare the clinical effects of improved phacoemulsification through limbus tunnel incision versus manual small-incision cataract surgery on ophthalmic operation vehicle.

METHODS: Totally 261 patients(261 eyes)were enrolled in non-randomized controlled retrospective study. There were 160 eyes of Group A were treated with improved phacoemulsification through limbus tunnel incision; 101 eyes of Group B were treated with manual small-incision cataract extracapsular extraction. Both of the two groups were implanted PMMA IOL during the surgery and were follow-up for postoperative 30d. The surgical operation time and surgical complications of the two groups were compared. Uncorrected visual acuity(UCVA)and surgery induced astigmatism(SIA)were recorded at postoperative 1, 7 and 30d.

RESULTS:The operation time of improved phacoemulsification through limbus tunnel incision was shorter than that of manual small incision cataract extraction(t=-6.419, P<0.001). UCVA greater than or equal to 0.5 of Group A were 110(68.8%), 115(71.9%)and 121(75.6%)at postoperative 1d, 7d and 30d, and that of Group B were 55(54.5%), 63(62.4%)and 68(67.3%). UCVA of Group A was better at postoperative 1d(χ²=5.441, P=0.020). The differences of UCVA greater than or equal to 0.5 between the two groups were not statistically significant at postoperative 7d and 30d. The overall difference of SIA between the two groups was not statistically significant(F=2.135, P=0.145). The difference of SIA within the two groups was statistically significant(P<0.001)in different point time. The difference in the methods of improved phacoemulsification through limbus tunnel incision and manual small incision cataract extraction was not sifnificant on SIA in different time points(F=1.314, P=0.264). There was no statistically significant difference between the two groups in posterior capsular rupture and corneal edema(P>0.05), but the difference in the anterior chamber reaction between the two groups was statistically significant at postoperative 1d(χ²=5.293, P<0.05).

CONCLUSION: Improved phacoemulsification through limbus tunnel incision has advantages over shorter operation time, better visual recovery, few syndromes and is worth promoting on ophthalmic operation vehicle.