小瞳孔白内障超声乳化手术中应用OASIS瞳孔扩张器的疗效观察

目的　评价小瞳孔白内障超声乳化手术中应用OASIS瞳孔扩张器的效果。方法　本文为前瞻性病例对照研究，收集临床工作中的小瞳孔白内障患者22例22眼，随机分为2组，其中术中采用器械瞳孔撕开操作13眼（A组），采用OASIS瞳孔扩张器扩张瞳孔9眼（B组）。所有病例均施行3.2 mm透明角膜切口超声乳化吸除，术后1周、1个月、3个月、6个月随访复查，比较手术前后最佳矫正视力（best corrected visual acuity，BCVA）、眼压、角膜内皮细胞计数、瞳孔大小变化。采用独立样本t检验的方法进行统计分析。结果　所有手术均由同一医师顺利完成，人工晶状体100%囊袋内植入，未见手术并发症发生。术后6个月BCVA（A组0.41±0.30 、B组0.77±0.23）与术前（A组0.17±0.14 、B组0.16±0.14）比较，2组均显著提高；但2组间差异无统计学意义（均为P>0.05）。术后6个月眼压:A组（14.62±4.70）mmHg（1 kPa=7.5 mmHg）、B组（12.67±6.35）mmHg，与术前A组（14.22±6.00）mmHg、B组（15.70±5.70）mmHg相比无明显变化；2组间差异均无统计学意义（均为P>0.05）。术后6个月角膜内皮细胞计数:A组（1486±718）个·mm^-2、B组（1246±516）个·mm^-2，与术前A组（2498±564）个·mm^-2、B组（2424±640）个·mm^-2均明显减少；B组角膜内皮细胞计数损失更多，差异无统计学意义（P=0.091）。2组瞳孔直径均较术前扩大:术前A组（2.30±0.35）mm、B组（1.94±0.50）mm，术后A组（4.00±0.88）mm、B组（4.70±1.57）mm，2组间差异均无统计学意义（均为P>0.05）。结论　小瞳孔白内障超声乳化手术时使用OASIS瞳孔扩张器辅助可在术中有效扩大并维持瞳孔扩张状态，不影响术后视力恢复和眼压情况；术后瞳孔较术前扩大，使用OASIS瞳孔扩张器时需要注意保护角膜内皮

Effects of OASIS iris expander in phacoemulsification surgery of cataract with small pupil

Objective　To assess the outcomes of OASIS iris expander in phacoemulsification surgery of cataract with small pupil.Methods　A prospective case-control study was conducted in 22 microcoria cataract patients (22 eyes).And they were randomly divided into group A and B，in which the pupils of group A were dilated by tearing instruments in 13 eyes，and the pupils of group B were dilated using OASIS iris expander in 9 eyes.All patient underwent phacoemulsification with 3.2 mm clear corneal incision and were followed up at postoperative 1 week，1 month，3 months and 6 months.Finally，the best corrected visual acuity (BCVA)，intraocular pressure (IOP)，corneal endothelial cell counts，pupil size before and after surgery were recorded and analyzed by an independent sample t test.Results　All procedures were completed successfully by the same skilled doctor.Intraocular lenses were implanted in capsule completely，and no complications occurred.At 6 months after operation，patients’ BCVA in group A (0.41±0.30) and group B (0.77±0.23) was significantly higher than that in group A (0.17±0.14) and group B (0.16±0.14) before operation，but there was no statistical difference between the two groups(all P>0.05)；whereas there was no significant change in the IOP of group A and B at 6 months after operation (1 kPa=7.5 mmHg) and before operation ［(14.22±6.00)mmHg vs.(15.70±5.70)mmHg)］(all P>0.05).Moreover，corneal endothelial cell counts in group A ［(1486±718) cells·mm^-2］ and B ［(1246±516)cells·mm^-2］ were significantly smaller than those before operation ［(2498±564)cells·mm^-2 vs.［(2424 ± 640)cells·mm^-2］，with no significant difference (P=0.091).The postoperative diameter of the pupil in group A ［(4.00±0.88)mm］ and group B ［(4.70±1.57)mm］ after operation was larger than that in group A ［(2.30±0.35)mm］ and group B ［(1.94±0.50)mm］ before operation，and there was no statistical difference between the two groups(all P>0.05).Conclusions　OASIS iris expander can help to dilate and hold pupils and does not affect the postoperative visual acuity and intraocular pressure in microcoria cataract phacoemulsification.The postoperative pupils become larger，and it is necessary to pay attention to protect corneal endothelial cell during usage of OASIS iris expander.