超声乳化手术不同长度角膜切口的比较

目的 比较2.2mm与2.75 mm同轴透明角膜切口超声乳化术中超声能量水平及术后角膜内皮细胞密度（CED）的变化.方法 前瞻、随机、对照性临床研究,将134例（167只眼）白内障按简单随机分组法分为两组：2.2mm切口组57例（70只眼）和2.75 mm切口组77例（97只眼）.记录两组术前晶状体核硬度分级,测量两组术前、术后1个月及3个月的CED,记录术中两组病例的超声乳化时间及平均能量,计算各自的有效超声时间（EPT）.比较两组之间及组内各时间点CED差异及两组术中EPT差异.结果 两组晶状体核硬度分级构成比差异无统计学意义,两组术中EPT比较差异无统计学意义（P＞0.05）,且均与核硬度分级呈明显正相关.两组术后CED均有所减少,2.2mm组：术前（2510.88±268.81）个/mm2,术后3个月（2378.8±369.93）个/mm2 （P＜ 0.05）;2.75mm组：术前（2524.62±251.69）个/mm2,术后3个月（2388.08±360.51）个/mm2（P＜0.01）.两组术后CED均于术后1个月开始稳定,术后3个月与1个月CED比较差异无统计学意义（P＞0.05）.两组之间CED变化幅度差异无统计学意义（P＞0.05）.结论 与2.75 mm切口组相比,2.2 mm切口组切口变小,手术难度加大,但没有增加术中超声能量,且两组术中所用超声能量水平均与晶状体核硬度分级呈正相关.两组间内皮细胞的丢失量的差异无统计学意义.

Comparison of phacoemulsification surgery with 2.2 mm or 2.75 mm corneal incision

Objective To compare the intraoperative ultrasound energy and the change of corneal endothelial cell density （CED） in 2.2 mm or 2.75 mm corneal incision phacoemulsification.Methods A prospective,randomized and controlled clinical study was conducted on 134 patients with 167 cataract eyes which were randomly divided into two groups：2.2 mm group （70 eyes of 57 patients） and 2.75 mm group （97 eyes of 77 patients）.The hard degree of the nucleus was recorded.The CED was measured preoperatively,1 month and 3 months postoperatively.It was compared between the two groups.The phaco time and average energy in the surgery were recorded to calculate the effective phaco time （EPT）.The intraoperative EPT was compared between the two groups.Results There was no statistically significant difference in nuclear hardness or in EPT between the two groups,but there was a positive correlation between them in both the two groups.Postoperative CED was reduced in 2.2 mm and 2.75 mm group as follows：（2510.88±268.81） mm-2 preoperatively and （2378.84±369.93） mm-2 at 3 months postoperatively （P 〈 0.05） in 2.2 mm group; （2524.62 ± 251.69） mm-2 preoperatively and （2388.08 ± 360.51） mm-2 at 3 months postoperatively （P 〈0.01） in 2.75 mm group.The CED trended to be stabilized 1 month postoperatively.There were no statistically significant difference in the changes of CED between the two groups （P 〉 0.05）.Conclusion Comparing with 2.75 mm incision,2.2 mm coaxial clear corneal incision is shorter in length and thus making more difficulty in the operation.However,intraoperative ultrasound energy has not increased in 2.2 mm incision system.The EPT is correlated with nucleus hardness.There is no statistically significant difference in postoperative CED loss between the two groups.