扭动模式超声乳化白内障吸除的初步临床研究

目的探讨一种新的超声振动模式-扭动模式(Torsional)用于白内障超声乳化吸除的有效性安全性。方法病例来自中山大学中山眼科中心,诊断单纯性老年白内障对其进行随机分组并行超声乳化白内障吸除,一组选用扭动模式,而另一组选用常规模式,记录术中所使用的超声时间(Ultrasound Time,UST)及超声能量(Cumulative Dissipated Energy,CDE),并比较术后角膜水肿程度、角膜厚度、术后的最佳矫正视力及角膜内皮细胞的丢失率。结果术中所使用的超声时间及超声能量比较,扭动模式组较常规模式组低,对于1、2、3、4级核,平均UST扭动模式组为8.32,18.45,29.48和48.39秒,而常规模式组为10.25,25.14,36.45和61.44秒;扭动模式组平均超声能量为0.94,3.13,7.47和14.08,常规模式组为1.25,4.18,8.59,16.51,之间的差异具有统计学意义。术后的平均最佳矫正视力比较,术后1天及术后7天扭动模式组较常规模式组高,而术后1月观察差异不具有统计学意义。角膜水肿及平均角膜中央厚度比较,术后1天及7天扭动模式组较常规模式组角膜水肿轻,术后30天比较它们之间的差异不具有统计学意义。术后7天及30天平均角膜内皮细胞计数比较,扭动模式组较常规超乳模式组高,丢失率低。结论扭动模式超声乳化白内障吸除较传统超乳模式相比,是一种高效安全的超声乳化振动模式,较传统模式相比可以减少术中的超声时间及超声能量,并减少对眼内组织特别是角膜内皮细胞的损伤。

A primary clinical research of Torsional phacoemulsification for cataract extraction

Objective To introduce a new ultrasound oscillation mode for cataract extraction and evaluate its efficiency and safety.Methods All the subjects came from the Zhongshan Ophtalmic Center and were diagnosed as cataract and assigned randomly to either phacoemulsification using Torsional mode or con-ventional ultrasound mode.The intraoperative data of Ultrasound Time(UST)and Cumulative Dissipated En-ergy(CDE)were measured and compared.Postoperative outcome measures the change of the best corrected visual acuity(BCVA),corneal clarity,corneal thickness and endothelial cell count were also measured and compared.Results For grade 1,2,3 and 4 nuclear density,mean UST and mean CDE were significantly lower in the Torsional group,mean USTs were 8.32,18.45,29.48 and 48.39 seconds in the Torsional group and 10.25,25.14,36.45,and 61.44 seconds in the Ultrasound group.Mean CDEs were 0.94,3.13,7.47 and 14.08 in the Torsional group and 1.25,4.18,8.59 respectively.The average best corrected visual acuity of the Torsional group was better than the Ultrasound group at 1day and 7days after surgery.But at 30days postoperative,there is no statistical difference between these two groups.The corneal clarity and the mean change of central thick-ness showed significantly less corneal edema in the Torsional group than the Ultrasound group in 1days and 7days postoperatively.This difference was no longer significant at 30 days after surgery.7 days and 30 days postoperative,the endothelial cells in Ultrasound groups were lower than the Torsional group.Conclusion The Torsional mode is a safe and effective phacoemulsification mode for cataract extraction as compared with the conventional mode.It can reduce the ultrasound time and ultrasound energy and reduce the intraocular trauma.