不同大小透明角膜切口超声乳化术治疗放射状角膜切开术后白内障

目的：评估不同大小透明角膜切口超声乳化术治疗放射状角膜切开术（RK）后白内障的临床效果。方法：回顾性系列病例研究。收集2011 年1 月至2015 年8 月在首都医科大学附属北京同仁医院行白内障超声乳化手术且既往有RK史的患者16例（26眼），其中RK角膜瘢痕为8刀者3例（6眼），12刀者8 例（12 眼），16 刀者5 例（8 眼）。由同一手术医师进行透明角膜切口白内障超声乳化术联合人工晶状体植入术，8 刀者中4 眼采用3.2 mm透明角膜切口，2 眼采用3.0 mm透明角膜切口；12 刀者中4 眼采用3.2 mm透明角膜切口，8 眼采用2.2 mm透明角膜切口；16 刀者中5 眼采用3.2 mm透明角膜切口，3眼采用2.0 mm透明角膜切口。分别于术后1 d，1 周，1、3、6、12、24、36 个月进行随访，观察并记录角膜RK瘢痕情况，术后视力恢复情况及术后有无并发症发生。对术前与术后1 个月、最后1 次随访时的各项参数采用配对t 检验进行比较。结果：RK角膜瘢痕为8 刀者和12 刀者术中均未发生RK瘢痕裂开，术毕切口密闭良好；16 刀者中采用3.2 mm透明角膜切口者2 眼术中发生角膜瘢痕裂开，前房注入无菌空气封闭切口，切口密闭良好，余6 眼均未发生术中角膜瘢痕裂开。术后随访时间为1~36（12.9±11.6）个月。26眼术后角膜切口密闭良好，均未出现新发角膜瘢痕裂开。最后1 次复查时最佳矫正视力（BCVA，LogMAR）为0.19±0.12，较术前提高（t =-6.913，P <0.001）；等效球镜度（SE）为（-0.43±1.64）D，较术前明显降低（t =-5.983，P <0.001）；角膜散光度为（1.92±0.85）D，与术前差异无统计学意义（t =-0.68，P =0.506）；角膜内皮细胞密度为（1 893±826）个/mm2，较术前明显降低（t =4.048，P =0.001）。结论：采用不同大小透明角膜切口超声乳化术治疗RK术后白内障临床效果均较好，相对安全，建议RK角膜瘢痕为8 刀者可采用3.2 mm及以下透明角膜切口，12 刀者可采用2.2 mm及以下透明角膜切口，16刀者可采用2.0 mm及以下透明角膜切口。

Phacoemulsification with Different Sizes of Clear Corneal Incisions in Cataract after Radial Keratotomy

Objective:To evaluate the clinical effect of phacoemulsification with different sizes of clear corneal incisions in cataract after radial keratotomy (RK).Methods:This retrospective case series study from January 2011 to August 2015,included 16 cases (26 eyes) of cataract patients with a history of RK more than 10 years.Three cases (6 eyes) had 8 RK incisions,8 cases (12 eyes) had 12 RK incisions,and 5 cases (8 eyes) had 16 RK incisions.All phacoemulsification and intraocular lens (IOL) implantations were performed through clear corneal incisions made by the same surgeon.For the cases with 8 RK incisions,4 eyes had a 3.2 mm clear corneal incisions and 2 eyes had a 3.0 nun clear corneal incisions.For the cases with 12 RK incisions,4 eyes had a 3.2 mm clear corneal incision and 8 eyes had a 2.2 mm clear corneal incisions.For the cases with 16 RK incisions,5 eyes had a 3.2 mm clear corneal incision and 3 eyes had a 2.0 mm clear corneal incisions.Dehiscence of the RK incisions,management of complications,and postoperative visual acuity recovery were observed 1 day,1 week,and 1,3,6,12,24,and 36 months after surgery.The preoperative and postoperative parameters were analyzed by paired t-tests.Results:In the cataract surgery,no RK incisions dehisced in any of the eyes with 8 or 12 RK incisions,and all of the clear corneal incisions closed well.For cataract surgery of 6 eyes following RK with 16 clear corneal incisions,there was also no dehiscence of the RK incisions,but for RK incisions adjacent to the clear corneal incision,two eyes dehisced.The dehiscence of RK incisions was closed by injecting an air bubble into the anterior chamber.The follow-up time (mean±SD) was 12.9±11.6 months.During the follow-up,the incisions closed well in all of the 26 eyes,and no new dehiscence of RK incisions occurred.In the last follow-up,the best corrected visual acuity (BCVA) was 0.19±0.12,which was better than the preoperative BCVA (t=-6.913,P＜0.001).The spherical equivalent refraction was-0.43±1.64 diopter (D),which was less than preoperative value (t=-5.983,P＜0.001).The corneal astigmatism was 1.92±0.85 D,and there was no difference with preoperative value (t=-0.68,P=0.506).The corneal endothelial cell density was 1 893±826 cells/mm2,which was less than preoperative value (t=4.048,P=0.001).Conclusions:Phacoemulsification and IOL implantation with clear corneal incisions in cataract patients after RK was effective and safe.Better results may be achieved with 3.2 mm or smaller clear corneal incisions in cataract surgery after RK with 8 incisions,2.2 mm or smaller clear corneal incisions after RK with 12 incisions,and 2.0 mm or smaller clear corneal incisions after RK with 16 incisions.