不同切口白内障超声乳化术的疗效及对角膜内皮细胞的影响

目的：探究3.0mm切口白内障超声乳化术与1.8mm同轴微切口白内障超声乳化术治疗疗效及对角膜内皮细胞的影响。

方法：选择2016-12/2018-12我院住院的78例78眼年龄相关性白内障患者作为研究对象,按照术中手术切口大小不同分为标准切口组及微切口组,每组39例39眼。标准切口组患者行3.0mm标准切口白内障超声乳化人工晶状体植入术,微切口组行1.8mm同轴微切口白内障超声乳化人工晶状体植入术,比较两组患者手术疗效及角膜内皮细胞参数。

结果：标准切口组及同轴微切口组患者超声乳化时间分别为7.05±0.98、7.22±0.96s,超声乳化能量分别为(17.01±1.89)%、(16.89±1.53)%(P>0.05); 与术前比较,两组患者术后裸眼视力(LogMAR)显著降低(P<0.001),散光程度加重(P<0.001),微切口组术后1d,1wk时裸眼视力及散光程度优于标准切口组(P<0.05); 两组患者术后1d,1wk,1、3mo内皮细胞密度显著降低(P<0.05),角膜内皮细胞变异系数、中央角膜厚度增大,两组间各时间点比较均无差异(P>0.05); 两组患者均无严重并发症,标准切口组患者1眼出现一过性高眼压,药物治疗后眼压恢复正常。

结论：同轴微切口白内障超声乳化手术与标准小切口手术均对内皮细胞形态及功能有一定影响,但两者无明显差异,但同轴微切口白内障超声乳化术可缩小手术切口,降低术源性散光程度,术后恢复快,是一种相对安全的手术方式。     

2.2mm微切口对白内障角膜内皮细胞丢失率及散射光变化分析

目的:探讨2.2mm微切口白内障超声乳化的临床效果.方法:选取2015-01/2016-02在我院行白内障超声乳化术联合人工晶状体植入术的白内障患者93例112眼,随机分为微切口组(47例52眼)和传统切口组(46例60眼),微切口组行2.2mm同轴微切口,传统切口组行3.2mm切口,观察两组平均超声乳化能量(AVE)、有效超声乳化时间(EPT)、角膜内皮细胞计数等.结果:微切口组和传统切口组术前及术后角膜内皮细胞比较差异无统计学意义(P＞0.05);术后3 mo微切口组和传统切口组角膜内皮细胞丢失率分别为(12.09±4.14)％和(13.24±5.44)％,差异比较无统计学意义(P＞0.05);微切口组AVE为(10.01±3.21)％,明显低于传统切口组,差异比较有统计学意义(P＜0.05);两组EPT比较差异无统计学意义(P＞0.05);微切口组和传统切口组术前及术后裸眼视力(LogMAR)比较差异无统计学意义(P＞0.05);微切口组术后1wk、1、3mo散光度为0.47±0.12、0.40±0.10、0.36±0.12D,明显小于传统切口组,差异比较有统计学意义(P＜0.05);两组术中及术后未发现有严重并发症.结论:2.2mm微切口超声乳化手术可有效节省超声能量,减少手术源性散光,有利于提高术后视觉质量,对角膜内皮细胞的损伤与传统切口无明显差异.     

同轴1.8mm微切口超声乳化白内障手术临床效果评价

目的 观察同轴1.8mm微切口超声乳化白内障手术的临床效果,并与传统同轴3.0mm小切口超声乳化手术进行比较.方法 前瞻性随机对照研究.采用随机数字表法,将实施超声乳化白内障手术的年龄相关性白内障患者89例(89只眼)随机分为2组.微切口组:同轴1.8mm微切口超声乳化白内障吸除联合人工晶状体植入手术45例(45只眼);小切口组:传统同轴3.0mm小切口超声乳化白内障吸除联合人工晶状体植入术44例(44只眼).取随访资料完整者,微切口组40例(40只眼),小切口组40例(40只眼)进行分析.分别记录两组超声乳化所用的平均超声能量(AVE)和有效超声时间(EPT),术后1d、1周、1个月和3个月随访,检查并记录视力、角膜内皮密度、中央角膜厚度,手术源性散光.采用两均数t检验和x2检验对数据进行统计学分析.结果 两组所用EPT和AVE差异无统计学意义(t=-0.149,P=0.882;t=-0.769,P=0.444).术后1d,微切口组裸眼LogMAR视力0.16±0.14优于小切口组0.23±0.12,且差异具有统计学意义(t=-2.371,P=0.020).术后1周、1个月和3个月,两组矫正视力差异均无统计学意义(t=-1.469,-1.437,-1.585;P=0.146,0.155,0.117).术后1d、1周、1个月和3个月,两组角膜内皮细胞密度及中央角膜增厚程度改变差异无统计学意义(P＞0.05).术后1d、1周、1个月及3个月,同轴微切口组手术源性散光分别为(0.62±0.28)D,(0.48±0.28)D,(0.47±0.25)D,(0.40±0.24)D;同轴小切口组手术源性散光分别为(1.27±0.65)D,(1.18±0.59)D,(1.02±0.56)D,(0.79±0.48)D,两组间差异具有统计学意义(t=-5.940,-7.247,-5.779,-4.788;P =0.000,0.000,0.000,0.000).微切口组手术源性散光于1周后明显下降(t=2.517,P=0.014)并趋于稳定,小切口组手术源性散光则于术后1个月出现明显下降(t =2.105,P=0.038).结论 同轴1.8mm微切口与传统的同轴3.0mm小切口超声乳化白内障手术相比,能有效减少手术源性散光,且散光状态更早稳定,对术后视力早期恢复具有优势.     

同轴1.8mm微切口白内障超声乳化吸除术的临床研究

目的：用前瞻性随机方法,对照研究1.8mm和3.2mm透明角膜切口同轴白内障超声乳化吸除术并人工晶状体植入的临床疗效。
　　方法：选取2012-12/2014-12在西安市第四医院眼科进行白内障超声乳化吸除人工晶状体植入术的年龄相关性白内障患者85例117眼,将患者按随机数字表法分为两组。微切口组43例59眼,行1.8 mm同轴白内障超声乳化吸除术;小切口组42例58眼,行3.2 mm同轴白内障超声乳化吸除术。术中分别记录平均超声能量( average ultrasound energy, AVE )和有效超声时间( effective phacoemulsification time,EPT),术前、术后1、7、30和90d分别进行裸眼LogMAR视力检查。术前、术后90 d分别检查角膜内皮细胞密度和角膜地形图。比较两组患者术中AVE和EPT、术后裸眼LogMAR视力和术后90 d角膜内皮细胞丢失率和手术源性散光的差异。
　　结果：两组患者间视力的整体差异无统计学意义(F=2.222,P=0.139)。两组内不同时间点的视力差异有统计学意义(F=231.968,P=0.000)。不同长度角膜切口与不同时间点的视力未见交互作用(F=0.666,P=0.428)。术后1 d微切口组的裸眼LogMAR视力为0.16±0.11,小切口组的裸眼LogMAR视力为0.22±0.18,两组比较差异有统计学意义(P<0.05),余时间点两组间视力差异无统计学意义( P>0.05)。微切口组和小切口组术中AVE分别为(7.00±2.72)%和(6.16±3.16)%,EPT分别为3.09±1.61s和3.20±1.92s,两组间差异均无统计学意义(P>0.05)。术后90 d微切口组和小切口组角膜内皮细胞丢失率分别为(5.81±2.28)%和(5.69±2.38)%,两组间差异无统计学意义(P>0.05)。术后90d微切口组和小切口组SIA分别为0.35±0.11D和0.61±0.13D,两组间差异有统计学意义(P<0.05)。
　　结论：与3.2mm同轴小切口白内障超声乳化吸除术比较,1.8mm同轴微切口术具有术后早期视力恢复快、术后晚期手术源性散光小等优点,而且不增加能量的使用,不加重角膜内皮细胞的损伤。     

微切口白内障超声乳化术后角膜地形图分析

目的 观察1.2mm微切口白内障超声乳化术后散光动态变化.方法 将75例(89只眼)老年性白内障患者随机分为两组,一组34例(40只眼)行双手超声乳化术,切口为1.2mm,植入Acri.Smart人工晶状体.另一组41例(49只眼)行传统超声乳化术,切口为3.2mm,植入AR40e人工晶状体.术前及术后1周、1月、3月行眼科常规检查及角膜地形图检查.分析患者术后视力和角膜地形图改变.结果 术后1d、1周双手组裸眼视力好于传统组,差异有统计学意义(P＜0.05).术后1周、1月双手组散光度数小于传统组(P＜0.05),术后1周、1月双手组的手术源性散光小于传统组(P＜0.01).传统组术后1周的SRI和SAI较术前增加,双手组术后1周的SRI和SAI小于传统组.双手组术前术后角膜地形图改变极小.结论 1.2mm微切口白内障超声乳化术切口小,对角膜形态影响小,散光小,视力恢复快.     

微切口超声乳化手术在硬核白内障病例中的效果评价

目的:观察2.2mm同轴微切口超声乳化手术在硬核白内障病例中应用的临床效果,并与传统3.0mm超声乳化手术进行比较。方法:将拟实施白内障超声乳化手术的硬核(Ⅳ级及以上)患者132眼根据手术切口的大小,分为2组。微切口组:2.2mm同轴微切口超声乳化白内障吸出联合人工晶状体植入术60眼;传统切口组:3.0mm切口传统超声乳化白内障吸出联合人工晶状体植入术72眼。观察两组后囊破裂和术后角膜水肿的发生率;记录两组超声乳化所用的平均超声能量(AVE),术后1d;1,3mo随访,记录视力,手术源性散光(SIA),术后3mo检测角膜内皮细胞密度并计算丢失率。将相关数据进行统计学分析。结果:后囊破裂和术后角膜水肿的发生率微切口组为3.3%,10.0%,传统切口组为4.2%,11.1%,差异无统计学意义。微切口组和传统切口组的平均超声能量分别为65.09±20.15,69.13±15.44,差异无统计学意义。术后1d平均裸眼视力微切口组优于传统切口组,差异有统计学意义(P<0.05)。术后1,3mo最佳矫正视力两组比较差别无统计学意义(P>0.05)。术后3mo角膜内皮细胞丢失率微切口组和传统切口组分别为(16.54±10.20)%,(17.69±10.65)%,差异无统计学意义。术后1d;1,3mo微切口组手术源性散光分别为0.77±0.31,0.66±0.29,0.52±0.25D;传统切口组分别为1.41±0.73,0.98±0.61,0.82±0.35D,差异有统计学意义。结论:2.2mm同轴微切口超声乳化手术技术应用在硬核白内障病例中,具有与传统3.0mm切口相似的安全性;能有效减少手术源性散光,对术后早期视力恢复具有优势。     

青光眼术后白内障的超声乳化人工晶状体植入

目的 探讨超声乳化联合折叠型人工晶状体植入术治疗青光眼术后白内障的临床疗效.方法 88例(90眼)青光眼术后白内障随机分为治疗组43例(45眼)和对照组45例(45眼),治疗组采用透明角膜切口晶状体超声乳化联合折叠型人工晶状体植入术,对照组常规采用白内障囊外摘出术.随访术后1周、1个月、3个月裸眼视力及角膜散光度.结果 治疗组术后1周、1个月和3个月裸眼视力＞0.5者明显高于对照组(P＜0.01).两组在术后3个月平均角膜散光度的差异有统计学意义(P＜0.01).结论 抗青光眼术后透明角膜切口晶状体超声乳化联合折叠型人工晶状体植入术具有较好的临床疗效,有利于减少术后角膜散光,获得更好的裸眼视力.     

双手法微切口白内障手术评价及术后早期视觉质量观察

目的 评价双手法微切口自内障摘除联合1.4mm微切口人工晶体植入手术技术的安全性、有效性及其术后早期视功能恢复情况.方法 选择2004年8月至2006年12月行老年性白内障摘除手术的患者320只眼,随机分成两组,A组进行常规3.0mm切口同轴超声乳化白内障摘除手术,B组进行微切口自内障摘除手术(MICS).术后一个月对两组术眼进行以下检查:裸眼远、近视力;最佳矫正远、近视力;自动验光仪验光观察角膜散光;全眼像差变化,并比较两组的差异.结果 术后1个月两组裸眼远视力有统计学差异,术后1个月两组手术前后散光变化有统计学意义(P<0.05),全眼总像差及高阶相差A组均高于B组,MICS组的观察结果优于常规同轴超声乳化组.结论 微切口白内障手术作为一种新的超声乳化手术技巧会逐渐发展完善,在临床中得到进一步应用.     

白内障小切口非超声乳化术向超声乳化术转型中的技术转变体会

目的:探讨白内障小切口非超声乳化术向超声乳化术转型中的技术转变.方法:对2009年4月-2009年12月"光明工程"中白内障超声乳化手术转型期193例193眼的情况进行回顾性分析,同期行小切口非超声乳化吸除术患者43例48眼作对照.结果:对照组术后第1日裸眼视力大于或等于0.5的比例高于治疗组(P＜0.05),术后第1周、第1个月裸眼视力大于或等于0.5及术后第1个月最佳矫正视力大于或等于0.5的比例,两组比较差异无统计学意义(均P＞0.05).对照组术后主要并发症比率均低于治疗组(均P＜0.05).结论:小切口非超声乳化术向超声乳化术转型中,因技术差异较大,发生后囊破裂和角膜内皮水肿的几率较高,转型此手术要有熟练的显微手术基础、处理并发症的能力和一定的设备条件.     

抗青光眼术后白内障行不同切口超声乳化术的临床疗效分析

目的对比分析抗青光眼术后白内障行不同切口超声乳化术的临床疗效。方法抗青光眼术后白内障患者51例(65眼),根据超声乳化术中切口选择不同分为2组,分别采用颞侧透明角膜隧道切口(A组)和上方透明角膜隧道切口(B组),观察2组患者术前、术后1周和1个月裸眼视力、眼压、角膜散光度及并发症情况,同时观察2组术后2周角膜、房水混浊程度。结果术前和术后1个月A、B组间裸眼视力差异均无统计学意义(均为P>0.05),而术后1周A组裸眼视力高于B组,差异有统计学意义(P<0.05)。A、B组术前眼压分别为(2.38±0.52)kPa、(2.25±0.82)kPa,术后1周分别为(2.10±0.45)kPa、(2.15±0.78)kPa,术后1个月分别为(2.01±0.22)kPa、(2.06±0.31)kPa。2组术前、术后1周、1个月眼压、角膜散光度差异均无统计学意义(均为P>0.05)。2组术后2周角膜、房水混浊程度差异均无统计学意义(均为P>0.05)。2组主要并发症为角膜水肿、虹膜损伤、后囊膜破裂。结论抗青光眼术后白内障行颞侧切口或上方切口超声乳化术的临床疗效无显著差异,但行颞侧切口患者术后裸眼视力恢复更快。     

双手法微切口超声乳化白内障吸除联合人工晶状体植入术的临床效果评价

目的 比较双手法微切口超声乳化白内障吸除联合人工晶状体植入术与常规同轴小切口超卢乳化白内障吸除联合人工品状体植入手术的临床效果.方法 采用前瞻性随机对照研究,将280例(280只眼)白内障患者采用随机数字表法分为两组,分别行双手法微切口超卢乳化白内障吸除联合人工晶状体植入术(微切口组,146只眼)和常规小切门超声乳化白内障吸除联合人工晶状体植入术(小切口组,134只眼).分别记录两组超声乳化所用的超声乳化时间和平均功率,计算绝对超卢乳化时间(绝对超声乳化时间=超声乳化时间×平均功率),检查患者术后1 d和3个月的视力、角膜厚度、角膜内皮细胞计数及房水闪光值,以矢量法计算两组患者术后3个月的手术源性散光,并观察手术并发症.采用两均数t检验和χ2检验分别对计量资料和计数资料进行统计学分析.结果 微切口组的超卢乳化时间、平均功率以及绝对超声乳化时间分别为(0.76±0.36)min、10.93%±4.78%及(8.99±7.23)min,均明显低于小切口组(F=4.649,30.072,21.837;P＜0.05).术后3个月,微切口组的手术源性散光[(0.37±0.32)D]显著低于小切口组[(1.28±0.77)D],两组比较差异有统计学意义(F=68.331,P=0.000).两组术后1 d和3个月的视力、房水闪光值、角膜内皮丢失率和角膜增厚程度的差异均无统计学意义(P＞0.05).结论 双手法微切口超声乳化白内障吸除术可以降低超声能量释放,提高乳化效率,并可减少手术源性散光,提高手术疗效;但与传统同轴小切口超声乳化白内障吸除术相比,并未能进一步减少眼内组织损伤和炎性反应.     

Controlled clinical trial comparing biaxial microincision with coaxial small incision for cataract surgery

Purpose. Clinical outcomes of biaxial microincision versus coaxial small incision cataract surgery were compared in a prospective, controlled, paired-eye clinical study. Methods. A total of 84 eyes of 42 patients underwent cataract surgery using the biaxial microincision (B-MICS) technique in either the right or left eye. The fellow eye was to undergo cataract surgery using the standard coaxial small incision (SICS) technique. All surgeries were performed using the Stellaris Vision Enhancement System and all eyes were implanted with an aspheric microincision intraocular lens (IOL). The 1.2-mm B-MICS incision was widened to 1.8 mm for IOL insertion. The main outcome measure was the change from baseline best-corrected visual acuity (BCVA). Secondary outcome measures were uncorrected visual acuity (UCVA), surgically induced astigmatism (SIA), manifest subjective refraction in spherical equivalent (MRSE), absolute phacoemulsification time (APT), effective phacoemulsification time (EPT), mean phacoemulsification power, and endothelial cell count (ECC). Follow-up was at 1 day, 3 days, 1 week, and 2 months. Results. The treatment groups did not differ in baseline characteristics. Improvement in BCVA over baseline logarithm of the minimum angle of resolution (logMAR) was statistically significantly greater with B-MICS than SICS at 1 day (B-MICS -0.1, SICS -0.05; 95% CI -0.26 to -0.05, p=0.005). Mean improvement in UCVA from baseline was greater with B-MICS at 1 day (B-MICS -0.33, SICS -0.12; 95% CI -0.35 to -0.10, p=0.001), 3 days (B-MICS -0.39, SICS -0.26; 95% CI -0.22 to -0.02, p=0.022), 1 week (B-MICS -0.44, SICS -0.33; 95% CI -0.20 to -0.009, p=0.033), and 2 months (B-MICS -0.47, SICS 0.38; 95% CI -0.19 to +0.002, p =0.054). At 2 months, SIA was significantly lower with B-MICS than SICS (B-MICS 0.70 D, SICS 0.89 D; 95% CI -0.39 to -0.1, p=0.045), as was endothelial cell loss (B-MICS -1.4%, SICS -7.8%; p=0.05). The EPT was lower with B-MICS (B-MICS 1.60 s, SICS 2.80 s; 95% CI -1.68 to -0.77, p<0.001) with no difference in mean phaco power. Conclusions. Compared to the standard small incision technique, B-MICS showed earlier improvement in BCVA, better overall UCVA, less SIA, and less endothelial cell loss.     

Outcomes of coaxial microincision cataract surgery versus conventional coaxial cataract surgery

PURPOSE: To compare the outcomes of coaxial microincision cataract surgery (MICS) with those of conventional coaxial cataract surgery. SETTING: University Eye Clinic, Geneva, Switzerland. METHODS: In a prospective study, 50 eyes of 50 patients with nuclear or corticonuclear cataract (grades 2 to 4 on the Lens Opacities Classification System III) were randomly selected to have cataract extraction through a temporal clear corneal incision using 1 of 2 techniques: coaxial MICS (25 eyes) or conventional coaxial cataract surgery (25 eyes). Coaxial MICS was performed through a 1.6 mm incision and conventional coaxial cataract surgery, through a 2.8 mm incision. In all cases, a flexible hydrophobic acrylic intraocular lens (Lentis L-303, WaveLight GmbH) was implanted. Intraoperative parameters were ultrasound time, surgical time, and total volume of balanced salt solution used. The best corrected visual acuity, corneal thickness, and endothelial cell count were evaluated preoperatively and postoperatively. RESULTS: There were no relevant clinical differences between groups or perioperative complications in either group. The only statistically significant differences between the 2 groups were ultrasound time (P = .0002) and surgical time (P = .005). CONCLUSIONS: Coaxial microincision cataract surgery was a safe and effective technique. Although ultrasound and surgical time were significantly higher with coaxial MICS than with conventional coaxial cataract surgery, the postoperative results in the 2 techniques were comparable.     

Intraindividual comparison of surgical trauma after bimanual microincision and conventional small-incision coaxial phacoemulsification

PURPOSE: To compare the surgical trauma after microincision phacoemulsification and small-incision coaxial phacoemulsification after implantation of conventional, foldable, hydrophobic acrylic intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A prospective investigator-masked case series comprised patients with bilateral cataract who had cataract surgery on the same day. Thirty-three patients (66 eyes) were randomized. Microincision cataract surgery (MICS) was performed through 2, 1.4 mm clear corneal incisions (CCIs) using bimanual sleeveless phacoemulsification (cool phaco) in 1 eye. Small-incision cataract surgery (SICS) was performed on the other eye through a 3.2 mm CCI. In all cases, an AcrySof SA60AT IOL was inserted, in the MICS group after the CCI was enlarged. Laser flare photometry, specular microscopy, corneal endothelial cell density, and pachymetry were evaluated preoperatively and postoperatively. Intraindividual comparison and statistical analyses were performed. RESULTS: There were no relevant clinical differences or perioperative complications in either group. There were no statistically significant differences between preoperative and postoperative anterior chamber flare or endothelial cell loss. On the first postoperative day, the MICS group had statistically significantly increased corneal swelling (P = .008). Postoperatively, the mean endothelial cell density loss was higher in the MICS group (6.2%) than in the SICS group (3.10%); however, the difference between groups was not significant (P = .08) CONCLUSIONS: Microincision cataract surgery was a safe and reproducible technique. The postoperative results in the MICS group were comparable to those in the SICS group.     

标准同轴晶状体乳化与微小切口白内障手术:一项角膜内皮的研究

目的:评估新的微小切口白内障手术(MICS)是否较标准同轴晶状体乳化引起较少的内皮损害方法:年龄相关性白内障患者 200 例随机分配接受标准同轴晶状体乳化(SCP)或 MICS 晶状体乳化。术前及术后1a 测量角膜中央及 12 点内皮细胞计数、细胞大小变异系数、六角形细胞百分比以及角膜中央厚度。结果:患者 173 例完成了试验。在 1a 的随访检查中,MICS 组内皮细胞损失为 6.5204%,而 SCP 组为 8.726%(P<0.00005)。两组在细胞大小变异系数、六角形细胞百分比、术后角膜厚度以及在切口部位和角膜中央测得的内皮细胞密度变异方面无显著差异。在硬性白内障患者中,与手术步骤无关,内皮细胞密度损失的增加量较高。结论:比较 SCP 与 MICS,本研究表明后者引起的内皮细胞密度损失明显地较低。     

西藏地区影响老年性白内障术后视力改善因素分析

目的 分析影响西藏地区老年性白内障术后视力改善的因素.方法 对西藏地区接受白内障手术的老年性白内障278例,分析年龄、核分级、术式(超声乳化术和小切口白内障囊外摘除术)、人工晶状体度数、角膜水肿部位等对术后视力改善的影响.视力采用LogMAR视力.统计方法分别采用单因素和多因素线性回归方法.结果 (1)单因素分析:术式:超声乳化术组术后较术前视力改善(平均视力差) 0.92±0.48,小切口白内障囊外摘除术组平均视力差0.83±0.46,两种手术方式对视力改善的影响,差异没有统计学意义(P＞0.05).年龄:70-、80-年龄组分别与40-、50-、60-年龄组差异有统计学意义(P＜0.05).角膜水肿部位:弥漫性水肿(平均视力差0.52±0.42)较中央部位水肿(平均视力差0.70±0.44))对视力改善影响更大,差异有统计学意义(P＜0.05).(2)多因素线性回归分析:年龄、角膜水肿部位均对视力改善有影响,差异有统计学意义(P＜0.05).结论 (1)超声乳化术和小切口白内障囊外摘除术两种手术方式对视力提高程度无明显差异,因此在西藏地区可以根据当地条件,包括经济状况和医师具备的手术水平,来选择术式,以使患者获得最佳有用视力.(2)年龄为白内障术后视力改善的影响因素之一,随年龄增加视力改善减少,而西藏地区就医条件有限,故在西藏地区更应重视白内障的普查,强调早期发现和早期手术.(3)在角膜水肿分级无明显差异的基础上,弥漫性水肿较中央部水肿对视力改善影响更大,因此在术中应谨慎操作,尽量避免角膜内皮广泛的损伤.     

Standard coaxial phaco microincision cataract surgery: a corneal endothelium study

To assess whether the new microincision cataract surgery (MICS) induces less endothelium damages than the standard coaxial phacoemulsification. · METHODS: Two hundred consecutive patients affected by age-related cataract were randomly assigned to undergo phacoemulsification using either standard coaxial phaco (SCP) or MICS. Central cornea and 12 o'clock endothelial cell count, cell size variation coefficient, percentage of hexagonality and central cornea thickness were measured before and up to one year after surgery. · RESULTS: One hundred and seventy-three patients completed the trial. At the one-year follow-up visit, the loss of endothelium cells was 6.5204% in the MICS group and 8.726% in the SCP group (P <0.00005). There were no significant differences between the two groups in terms of coefficient of variation in cell size, percentage of hexagonal cells, corneal thickness the day after surgery and variation of endothelial cell density measured both at the incision site and at the central cornea. In patients with hard cataracts, the increase in endothelial cell density loss was higher indepen- dently of the procedure. · CONCLUSION: MICS induces a significant lower endothelial cell density loss than SCP.