两种超声乳化手术模式在不同核硬度白内障手术中的应用

Application of two phacoemulsification modes in cataract surgery with different hard nuclear

摘要:

目的：观察Balanced平衡能量系统和常规扭动超声系统用于不同核硬度白内障超声乳化术中的临床效果。

方法：选取2021-11/2022-11于我院行白内障手术的年龄相关性白内障患者120例122眼，随机分为试验组(58例59眼，术中使用Balanced平衡能量系统)和对照组(62例63眼，术中使用常规扭动超声系统)。记录术中累计消耗能量(CDE)、总手术时间(CT)、灌注抽吸时间(AST)、灌注液用量(EFU)等参数。术后随访3mo，检查并记录最佳矫正视力(BCVA)和角膜内皮细胞密度(ECD)，并计算角膜内皮细胞丢失率。

结果：两组患者术中参数比较，CT无明显差异(P>0.05)，但试验组患者CDE、AST及EFU均低于对照组(P<0.05)，且试验组中Ⅲ级核硬度患者CDE低于对照组(P<0.05)，Ⅳ级核硬度患者CDE、AST及EFU均低于对照组(P<0.05)。随访3mo，两组患者BCVA均明显改善，且试验组较对照组恢复更快。术后3mo，两组患者ECD均较术前减少(P<0.01)，但试验组患者术前、术后3mo ECD及角膜内皮细胞丢失率与对照组均无差异(P>0.05)，试验组中Ⅳ级核硬度患者角膜内皮细胞丢失率明显低于对照组(4.63%±4.10% vs 6.63%±4.49%，P<0.01)。

结论：Balanced平衡能量系统和常规扭动超声系统用于不同核硬度白内障超声乳化术均具有较高的安全性和高效性，而前者术中使用的超声能量更低、灌注抽吸时间更短、灌注液用量更少，在硬核的应用中具有更明显的优势。

Abstract:

AIM: To compare the clinical efficacy of the Balanced energy system versus the conventional torsional ultrasound system in phacoemulsification surgeries for cataracts with varying nuclear hardness.

METHODS: In this study, 120 patients(122 eyes)with age-related cataracts scheduled for surgery between November 2021 and November 2022 at our hospital were randomly divided into two groups: 58 patients(59 eyes)in the experimental group underwent surgery using the Balanced energy system, while 62 patients(63 eyes)in the control group were treated with the conventional torsional ultrasound system. Intraoperative cumulative dissipated energy(CDE), case time(CT), aspiration time(AST), and estimated fluid used(EFU)were recorded. Patients were followed-up for 3mo to examine and record the best-corrected visual acuity(BCVA)and corneal endothelial cell density(ECD), and to calculate the rate of endothelial cell loss.

RESULTS: Comparing the intraoperative parameters between the two groups, there was no significant difference in CT(P>0.05), but the CDE, AST and EFU of the patients in the experimental group were lower than those of the control group(P<0.05), and the CDE of patients with grade III nuclear hardness in the experimental group was lower than the control group(P<0.05), CDE, AST and EFU in patients with grade IV nuclear hardness were lower than those in the control group(P<0.05). After 3mo of follow-up, BCVA in both groups improved significantly, and the experimental group recovered faster than the control group. At 3mo after surgery, the ECD of the two groups of patients was reduced compared with that before surgery(P<0.01), but there were no significant differences in ECD and endothelial cell loss rates between the experimental and control groups before and at 3mo after surgery(P>0.05). In grade IV nuclear hardness cataracts, the rate of endothelial cell loss in the experimental group was significantly lower than that in the control group(4.63%±4.10% vs. 6.63%±4.49%, P<0.01).

CONCLUSION: The Balanced energy system and the conventional torsional ultrasound system both show high safety and efficiency in phacoemulsification of cataracts with different nuclear hardness. However, the former demonstrates substantial advantages in cases with dense nuclei, offering lower ultrasound energy, shorter aspiration and infusion times, and reduced volume of infusion fluid.