不同超乳劈核术式治疗硬核白内障疗效及对角膜内皮的影响

Application of different phacoemulsification and chopping techniques in hard nuclear cataract surgery

摘要:

目的：分析超声乳化针头斜面向上劈核技术与超声乳化针头斜面向下完成晶状体核去除术(Phaco drill术式)在硬核白内障手术中的应用及对患者角膜内皮的影响。

方法：回顾性研究。选取2018-08/2020-04我院收治的硬核(Ⅳ～Ⅴ级)白内障患者94例104眼为研究对象，均行超声乳化白内障吸除术，术中采用超声乳化针头斜面向上劈核技术的患眼50眼为对照组，使用Phaco drill术式的患眼54眼为观察组，记录两组患者术中所用超声时间、超声能量及累积能量复合参数，对比两组患者术后最佳矫正视力(BCVA)、角膜水肿情况、角膜内皮细胞计数和正常六边形细胞比率。

结果：观察组患者超声时间、超声能量与累积复合能量参数均较对照组低(P<0.05)； 两组患者术后BCVA较术前均改善(P<0.05)； 术后1、2mo两组患者角膜内皮细胞计数、正常六边形细胞比率均低于术前，且观察组术后1、2mo角膜内皮细胞计数、正常六边形细胞比率均高于对照组(P<0.05)； 术后24h，7d观察组角膜水肿程度低于对照组(P<0.05)。

结论：与超声乳化针头斜面向上劈核技术相比，Phaco drill术式治疗硬核白内障可明显减少超声时间、超声能量，促进视力恢复，减少角膜内皮细胞损伤。

Abstract:

AIM: To analyze the efficacy of bevel-up phaco chop versus bevel-down phaco drill in the treatment of hard nuclear cataract and the influence on corneal endothelium.

METHODS: Between August 2018 and April 2020, 94 patients(104 eyes)with hard(grade Ⅳ-Ⅴ)nuclear cataract treated with phacoemulsification were enrolled in this retrospective study. Among them, 50 eyes treated by bevel-up phaco chop were included in the control group, while 54 eyes treated by phaco drill technique were included in the observation group. The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter in the two groups were recorded. The best corrected visual acuity(BCVA)in 7d, corneal endothelial cell count in 2mo, the proportions of normal hexagonal cells and the degree of corneal edema in 7d were compared between the two groups.

RESULTS: The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter of the observation group were shorter and lower than those of the control group(P<0.05). The BCVA of both groups increased after operation, and the observation group had higher BCVA than the control group at the same time(P<0.05). In 1 and 2mo, the corneal endothelial cell counts and the proportions of normal hexagonal cells in both groups were lower than those before operation. Meanwhile, the corneal endothelial cell count and the proportions of normal hexagonal cells in the observation group were higher than those in the control group(P<0.05). Besides, corneal edema was milder in the observation group than in the control group at 24h and 7d after operation(P<0.05).

CONCLUSION: Compared with bevel-up phaco chop, phaco drill can significantly shorten the time of using ultrasound, reduce ultrasound energy, promote visual recovery, and reduce corneal endothelial cell damage.