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1.
目的:比较在微切口同轴扭动超声乳化使用直头和弯头的术中表现和术后结果。

方法:白内障患者行2.2mm横向劈核微切口同轴超声乳化术中使用30° 直头或弯头进行治疗。术中检查分析包括平均超声功率,总超声乳化时间,有效的超声乳化时间。使用非接触镜显微镜评估术前和术后1d, 7d和30d的中央内皮细胞密度和角膜中央厚度。

结果:此研究共纳入白内障患者190例190眼,95眼为弯头组,95眼为直头组。术中检查显示弯头组总超声乳化时间和有效的超声乳化时间较直头组显著降低(P<0.05)。弯头组总超声乳化时间和有效的超声乳化时间中位数分别为25.9(13.5-45.0)s(四分位间距)和18.0(9.0-30.0)s,直头组分别为38.8(16.5-73.5)s和26.0(11.0-49.0)s。

结论:横向劈核微切口同轴超声乳化术中,相比较直头,使用弯头可以更加有效的摘除晶体,在所有阶段中除了第四阶段,总超声乳化时间和有效的超声乳化时间更短。  相似文献   


2.
Purpose: To compare the outcomes of cataract surgery performed with three different types of the epinucleus removal techniques (safe boat, infusion/aspiration (I/A) cannulas, and phacoemulsification tip). Methods: Ninety eyes with thick adhesive epinuclei were randomly subdivided into three groups according to epinucleus removal technique: epinucleus floating (safe boat) technique, 30 patients; I/A tip, 30 patients; and phaco tip, 30 patients. Intraoperative measurements included ultrasound time (UST), mean cumulative dissipated ultrasound energy (CDE), and balanced salt solution (BSS) use. Clinical measurements were made preoperatively, and at one day, one month and two months postoperatively, including the best corrected visual acuity (BCVA), the central corneal thickness (CCT), and the endothelial cell count (ECC). Results: Intraoperative measurements showed significantly less UST, CDE, and BSS use in the safe boat group than in the phaco tip groups (p?p?Conclusions: The safe boat technique is a safer and more effective epinucleus removal technique than phaco tip techniques in cases with thick epinucleus.  相似文献   

3.
PURPOSE: To compare the efficiency of surgical procedures using 2 phacoemulsification tips. SETTING: Wolfe Clinic, Marshalltown, Iowa, USA. METHODS: A randomized prospective study of 256 consecutive cases was conducted. The patients were adults having phacoemulsification by a modified in situ fracture technique. All cases were done by 1 surgeon using the Alcon Legacy 20000 phacoemulsification machine with high-vacuum cassettes and tubing. One of 2 45-degree Aspiration Bypass System (ABS) phacoemulsification tips was used. The straight tip has a 0.9 mm outside diameter (n = 127). The flared tip has a 0.76 mm outside diameter shaft that flares to a 1.02 mm tip (n = 129). Measurements at the time of surgery included metered phacoemulsification time, percentage power used, total phacoemulsification time, and milliliters of balanced salt solution (BSS(R)) used. RESULTS: No posterior capsule tear, vitreous loss, incision thermal damage, incision leak, or suture closure occurred. There were no cases of iris aspiration into the working end of the phacoemulsification needle; however, the iris was aspirated into the ABS opening of the flared tip in 1 case. Similar measurements for the straight and flared tips included, respectively, metered phacoemulsification time, 1.4 minutes each; mean power percentage, 41% and 39%; total phacoemulsification time, 2 minutes 11 seconds and 2 minutes 15 seconds; and overall BSS volume, 77 mL and 75 mL. The anterior capsule tear rates for straight (5.5%) and flared (1.6%) tips were similar. CONCLUSIONS: The flared ABS phaco tip with a 0.76 mm shaft outside diameter provided the physical advantages of shaft diameter reduction and required ultrasonic energy expenditures, BSS volumes, and surgical times similar to those of the straight ABS ultrasonic tip with a 0.9 mm outside diameter.  相似文献   

4.
Purpose: To evaluate the efficacy and postoperative outcomes of bimanual and micro‐coaxial phacoemulsification with torsional ultrasound. Methods: In this prospective randomized series, eyes with age‐related cataract were randomly divided into bimanual phacoemulsification and micro‐coaxial phacoemulsification groups. Data included preoperative and postoperative corrected distance visual acuity (CDVA), central/temporal corneal thickness, endothelial cell density and intraoperative ultrasound time, cumulative dissipated energy and balanced salt solution volume. Results: The study evaluated 89 patients (89 eyes). When compared between micro‐coaxial and bimanual phaco groups, ultrasound time (57 ± 24 second versus 85 ± 40 second, p < 0.01), cumulative dissipated energy (10 ± 7 versus 14 ± 7, p = 0.01) and balanced salt solution volume (55 ± 19 ml l versus 75 ± 20 ml, p < 0.01) were significantly lower in micro‐coaxial phaco group. At 1 day, there were no statistically significant differences in CDVA (p = 0.68) or central corneal thickness (p = 0.48) between two groups; temporal corneal thickness was statistically significantly thicker in bimanual phaco group (1247 ± 123 μm) than that in micro‐coaxial phaco group (1108 ± 131 μm, p = 0.01). There were no statistically significant differences in CDVA, central/temporal corneal thickness, or endothelial cell density between two groups 30 days postoperatively (all p values >0.05). Conclusion: With rapid visual rehabilitation and comparable endothelial cell loss, both bimanual and micro‐coaxial phacoemulsification procedures with torsional ultrasound are efficient for moderate nuclear cataract extraction.  相似文献   

5.
Purpose: To compare intraoperative efficiency and postoperative outcomes of cataract surgery with low and high fluidic settings. Methods: In this prospective, randomized, single‐blinded study, 114 eyes of 57 patients were operated with low fluidic settings for one eye (group I) and high fluidic settings for the other eye (group II). Efficiency was judged as metred surgery time, effective phacoemulsification time (EPT) and the amount of balanced salt solution used. Visual outcome and endothelial cell count were determined 1 week and 18 months postoperatively. Results: The overall effective phacoemulsification energy was statistically significantly lower (p = 0.003) in group II than in group I. Conquest of the nuclei was achieved with about two‐thirds of the energy needed in group I, with 6.59 ± 4.79 effective ultrasound energy compared with 3.99 ± 3.18 (p = 0.001). Overall, about 12% more solution was used in group II than in group I. Median visual acuity was 1.0 for both groups 18 months after surgery. The mean endothelial cell loss was 5.0% in eyes in group I compared with 6.3% in eyes in group II (p > 0.5). Conclusion: Switching from low fluidic settings with a conventional coaxial 20G phacoemulsification tip to higher fluidic settings with a microcoaxial phaco tip statistically significantly decreases EPT. As only marginally more solution was used with the higher aspiration flow, occlusion must be accomplished more often with high than with low fluidics. Aspiration of the quadrants was therefore more efficient with high fluidic settings. The enhanced pump speed did not result in more tissue damage.  相似文献   

6.
AIM: To compare intraoperative phacoemulsification parameters and its effect on the corneal endothelium of eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) cataract surgery. METHODS: Two hundred eyes from one hundred patients were included in a prospective, non-blinded, randomized, controlled, intraindividual clinical study. One hundred eyes underwent FLACS while their one hundred fellow eyes underwent CP. All surgeries were performed using the Victus® femtosecond laser platform and Infinity® Vision System phacoemulsification machine. Primary outcome measure was endothelial cell density 6mo after surgery. Secondary outcome measures included central corneal thickness (CCT), average cell area, standard deviation, coefficient of variation and hexagonality before surgery and 6mo after surgery and endothelial cell density loss during this period were also evaluated. Intraoperative efficiency parameters [cumulative dissipated energy (CDE), total intraocular surgery time, total ultrasound time, total phacoemulsification time, total torsional energy time, total aspiration time, ultrasound energy, torsional amplitude and fluid required during surgery] were also collated. RESULTS: Data from these patients was not considered for analysis. Data from 92 patients were analysed. Postoperative endothelial cell density (cells/mm2) between groups (2211.88±392.49 CP; 2246.31±403.48 FLACS) was not statistically significant (P=0.869). Total ultrasound time, torsional energy time, CDE and fluid requirements were significantly lower the FLACS group (P<0.05). Other parameters did not show statistically significant difference between FLACS and CP. CONCLUSION: FLACS displays significant improvements in phacoemulsification parameters in comparison to CP. There are no significant differences in corneal endothelium measures between FLACS and CP.  相似文献   

7.

Purpose

To compare thermal and mechanical clear corneal incision (CCI) injuries after conventional and torsional phacoemulsification.

Design

A prospective, randomized clinical study.

Methods

A total of 80 eyes were evaluated for the profile of the incision at 1 day and 3 months postoperatively. The wound architecture was recorded with anterior segment optical coherence tomography (AS-OCT). The incisional thickness increased by thermal injury, Descemet’s membrane detachment (DMD) caused by mechanical injury, the presence of endothelial gaping, loss of coaptation, and wound retraction of the conventional phaco group and the torsional phaco group were compared.

Results

The corneal thickness at the incision site of the torsional ultrasound group was significantly lower than the conventional group compared to at the first postoperative visit (1187.55?±?75.66, 1233.62?±?85.87, P?=?.013). However, this thickness was similar between the two groups at 3 months postoperatively. The central endothelial cell loss was significantly lower in the torsional ultrasound group after 3 months (417?±?143, 322?±?130, P?=?.003). There was a positive correlation between cumulated dissipated energy (CDE) and the incisional corneal thickness change that was observed by AS-OCT. Other OCT outcome parameters (such as endothelial gap, DMD, epithelial gap, and uncoaptation) that may be caused by mechanical injury did not differ significantly between the groups on postoperative day one or after 3 months.

Conclusions

The torsional ultrasound mode may provide a lower level of phacoemulsification time and energy and induce less incisional corneal thickness caused by thermal injury in the early postoperative period. The long-term wound healing appeared the same in both ultrasound mode groups.  相似文献   

8.
PURPOSE: To compare the efficiencies of the operative procedures and the reductions in postoperative corneal endothelial cell density (ECD) after cataract surgery using 2 different phacoemulsification tips and their associated cassettes and tubing. SETTING: Wolfe Clinic, Marshalltown, Iowa, USA. METHODS: A randomized prospective study of 100 consecutive cases was conducted. All patients were adults having phacoemulsification using a hybrid in situ fracture technique. All cases were performed by 1 surgeon using the Alcon Legacy 20000 phacoemulsification machine. One of 2 45 degree phacoemulsification tips and associated cassettes and tubing were used: the 1.1 mm TurboSonics with normal tubing (n = 47) or the 0.9 mm Aspiration Bypass System (ABS) tip with high-vacuum cassettes and tubing (n = 53). Measurements at the time of surgery included metered phacoemulsification time, percentage power used, total time spent in the phacoemulsification process, and milliliters of balanced salt solution (BSS) used. Corneal ECD was determined preoperatively and 10 weeks postoperatively. An independent statistician performed 2-sample t tests or Wilcoxon rank sum tests on the data. RESULTS: There were no cases of anterior radial capsule tear, posterior capsule tear, vitreous loss, iris aspiration, incision leak, or suture closure. There was no correlation between amount of corneal ECD loss and any operative variable measured. Similar measurements for the 1.1 mm TurboSonics and the 0.9 mm ABS included, respectively, ECD loss 7.34% and 8.22%; metered phacoemulsification time 1.29 and 1.22 minutes; total time of the phacoemulsification process 113 and 105 seconds. There were statistically significant differences between the 1.1 mm TurboSonics tip and 0.9 mm ABS tip performance in mean power percentage overall (52% versus 48%) and overall BSS volume used (85 versus 76 mL). CONCLUSIONS: The 0.9 mm ABS phacoemulsification tip used with the high-vacuum cassette and tubing provided the physical advantages of tip-size reduction while requiring similar ultrasonic power and BSS volumes as the 1.1 mm TurboSonics tip with standard cassette and tubing. Together, they provide a wider available dynamic range in which to integrate ultrasonic power, higher vacuum, and higher aspiration flow rates to improve the efficiency and ease of use than the standard 1.1 mm TurboSonics cataract operation.  相似文献   

9.

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。  相似文献   


10.
AIM: To compare under similar conditions intraoperative surgical efficiencies metrics between an active fluidics and a gravity based phacoemulsification systems. METHODS: Adult patients who were diagnosed with a cataract that compromised visual acuity inferior to 20/40 were included in the study. Patients were excluded from the study if they had a history of severe retinal disorders, clinically significant corneal endothelial dystrophy or history of corneal disease. All phacoemulsification surgeries were performed by a single surgeon. Both phacoemulsification systems used the 0.9 mm 45-degree aspiration bypass system Intrepid Balanced tip and the 0.9 mm Intrepid Ultra infusion sleeve. All cataracts were classified using the Lens Opacities Classification System III, cumulative dissipated energy (CDE) and aspiration fluids were measured in each surgery. RESULTS: Totally 2000 eyes were included in the study. Phacoemulsification was performed in 1000 (50%) eyes with an active fluid dynamics system and in 1000 (50%) eyes with a gravity-based fluidic system. Mean CDE until fracture of the lens was 1.1 and 1.9 percent-seconds and total mean CDE used was 5.6 and 7.2 percent-seconds using an active fluidics dynamics system and gravity-based fluidic system, respectively (P<0.001). Mean aspiration fluids used were 70 mL using an active fluidics dynamics system and 84 mL using a gravity-based fluidic system (P<0.001). CONCLUSION: This study evidences that surgeries performed under similar conditions (same surgeon, phaco tip and sleeve) with the active fluidics dynamics system required significantly lower CDE and aspiration fluids.  相似文献   

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