前房维持器下爆破与连续模式硬核白内障超声乳化术对角膜内皮细胞的影响

目的 探讨前房维持器下爆破与连续两种模式硬核白内障超声乳化术对角膜内皮细胞的影响.方法 将63例（63眼）Ⅳ级硬核白内障患者连续随机分为两组：前房维持器下爆破模式组32例（32眼）、前房维持器下连续模式组31例（31眼）.比较两组术中并发症、术后非矫正远视力（Uncorrected distance visual acuity,UCDVA）、角膜切口水肿情况、角膜内皮细胞损失率、角膜内皮六角形细胞比例,累积能量复合参数（Accumulated energy complex parameter,AECP）等.随访1个月.结果 前房维持器下爆破模式组与前房维持器下连续模式对照组比较：术后1个月UCDVA（已转换为logMAR分值）分别为（0.23±0.16）分及（0.31±0.23）分,差异无统计学意义（P＞0.05）;术中发生后囊破裂者仅连续模式组1例,差异无统计学意义（P＞0.05）;而术中浅前房发生率分别为6.25％及54.84％、术后1d角膜水肿的发生率分别为6.25％及45.16％、术后1个月角膜内皮细胞损失率分别为（0.1 1±0.11）％及（0.17±0.12）％,角膜内皮六角形细胞比例下降幅度分别为（4.98±4.21）％及（8.25±7.63）％,术中AECP分别为（416.21±605.87）及（1144.77±715.95）,爆破模式组较连续模式组均有显著降低（P＜0.05）.结论 前房维持器下爆破与连续两种模式均能安全、有效、简化、易行地实施硬核白内障超声乳化摘除术,均为理想的术式选择,但两种方法比较,前房维持器下爆破超声能量模式可明显降低超声乳化白内障吸除术的AECP,还可以减轻眼内组织的损伤程度,降低角膜水肿的发生率,减少角膜内皮细胞损伤率,值得推广使用.

Effect of hard nucleus cataract with burst and continuous mode during phacoemulsification under anterior chamber maintenance on corneal endothelial cell

Objective To evaluate the effect of hard nucleus cataract with burst and continuous mode during phacoemulsification under anterior chamber maintenance on corneal endothelial cell.Methods Sixty-three patients （63 eyes） of Ⅳ grade hard nuclear cataract treated by phacoemulsification and intraocular lens implantation were divided into two groups randomly：burst mode group （n=32,32 eyes,burst mode under the anterior chamber maintainer,continuous mode group （n=31,31 eyes,continuous mode under anterior chamber maintainer.Intraoperative complications,postoperative uncorrected distance visual acuity （UCDVA）,comeal incision edema,corneal endothelial cell loss rate,the proportion of hexagonal cells,accumulated energy complex parameters （AECP） were recorded.The patients were followed up for 1 month.Results The difference on UCDVA （changed to logMAR score） 1 month after treatment of the two groups was not statistically significant,（0.23±0.16） and （0.31±0.23）,respectively.Intraoperative posterior capsular rupture was only found in the continuous mode group （1 case）,showing no statistically significant difference with that in the burst mode group （0 case）,P〉0.05.In the burst mode group,the shallow anterior chamber incidence,corneal edema 1 day after surgery,corneal endothelial cell loss rate 1 month postoperative,the percentage of hexagonal cells of the comeal endothelium decline and the ACEP intraoperative 6.25%,6.25%,（0.15±0.11）%,（4.98± 12.21）%,（416.21±605.87）,respectively] were significantly reduced compared with the continuous mode group 54.84%,45.16%,（0.17±0.12）%,（8.25±7.63）%,（1144.77±715.95）],P〈0.05.Conclusion Hard nucleus cataract with burst and continuous mode during phacoemulsification under anterior chamber maintenance are both safe,effective,simplified and easy to implement,but the burst mode can significantly reduce the phacoemulsification surgery ACEP and the extent of tissue damage within the eye,which lead to lower incidence of corneal edema and rate of corneal endothelial cell damage.