压核进钩劈核技术与乳化劈核技术在白内障超声乳化手术的应用比较

Comparison of press-and-chop and Nagahara phaco-chop phacoemulsification nucleotomy techniques

摘要:

目的：分析压核进钩劈核技术与乳化劈核技术在白内障超声乳化手术的应用比较，探讨压核进钩劈核技术的优点。

方法：将年龄相关性白内障70例70眼随机分为压核进钩劈核组35例35眼和乳化劈核组35例35眼。分别使用压核进钩劈核技术、乳化劈核技术进行白内障超声乳化摘除术。两组病例均完成透明角膜切口、撕囊、水分离后，压核进钩劈核组先用超乳针头吸除表层皮质和软核，轻压晶状体核，然后用劈核钩勾住晶状体5：00位赤道部，超乳针头退回主切口，吃进晶状体核与劈核钩对向用力，将核一分为二。乳化劈核组用超乳针头吃入晶状体核心至晶状体1/2～2/3厚度并吸住晶状体核，劈核钩划入超乳针头对侧晶状体赤道部与超乳针头对向用力劈开晶状体核。记录两组术中实际超声乳化时间(U/S time)、术前及术后1mo角膜内皮细胞计数、角膜内皮细胞丢失率、术后1、7d角膜水肿、术前术后最佳矫正视力等情况并进行比较。

结果：压核进钩劈核组的U/S time低于乳化劈核组[12.76(8.76，16.76)s vs 22.87(18.36， 27.38)s， P<0.01]； 压核进钩劈核组术后1mo平均角膜内皮细胞计数高于乳化劈核组(2133.44±348.58/mm² vs 1957.94±280.54/mm²，P<0.05)，压核进钩劈核组术后1mo平均角膜内皮细胞丢失率低于乳化劈核组[0.15(0.08，0.22)vs 0.22(0.16， 0.28)， P<0.01]。术后1d压核进钩劈核组角膜水肿轻于乳化劈核组(Z=13.195，P=0.004)，术后7d两组角膜水肿均消退。术后1d两组视力较术前均有提高，而两组间无差异(Z=-0.48，P=0.63)。

结论：与乳化劈核技术相比，压核进钩劈核技术劈核操作简单，手术安全且并发症少。

Abstract:

AIM: To discuss the advantages of press-and-chop technique compared with Nagahara phaco-chop technique.

METHORDS: Totally 70 patients(70 eyes)with age-related cataract were randomly divided into 2 groups, press-and-chop technique group(35 patients 35 eyes), phaco-chop technique group(35 patients 35 eyes). In all cases, surgery began with a clear corneal incision, capsulorhexis and hydrodissection. In the press-and-chop technique group, the superficial cortex and epinucleus were aspirated by the phaco tip, then press the center of the lens front surface with the phaco tip. The Nagahara chopper was set around the lens equator, then the phaco tip was driven into the nucleus from the main incision, pull the Nagahara chopper toward the phaco tip. The two instruments were then separated laterally to produce a complete fracture of the nucleus. In phaco-chop technique group, the phaco tip was buried in the center of the endonucleus. The Nagahara chopper was brought through the side-port incision and the equator of endonucleus was engaged by the chopper under the lower edge of the capsulorhexis and pulled toward the phaco tip. The 2 instruments were then separated laterally to produce a complete fracture of the nucleus. The U/S time, preoperative and postoperative corneal endothelial cell density, corneal endothelium loss rate, corneal edema at 1d, 7d, best corrected visual acuity before and after surgery were recorded.

RESULTS: The U/S time of press-and-chop technique group was lower than phaco-chop technique group [12.76(8.76,16.76)s vs 22.87(18.36, 27.38)s, P<0.01]. The corneal endothelial cells density in press and chop technique group was higher than that in phaco-chop technique group 1mo after operation(2133.44±348.58/mm² vs 1957.94±280.54/mm², P<0.05), and the variation rate of corneal endothelial cells in press-and-chop technique group was lower than that in phaco-chop technique group 1mo after surgery [0.15(0.08,0.22)vs 0.22(0.16, 0.28), P<0.01]. The corneal edema in press-and-chop technique group was lighter than that in phaco-chop technique group on the first day after surgery(Z=13.195, P=0.004), and corneal edema in both groups subsided on the 7d after surgery. There was no significant difference between two groups in BCVA on the first day after surgery(Z=-0.48, P=0.63).

CONCLUSION: Compared with Nagahara phaco-chop technique, press-and-chop technique is simple and safe with less complications.