同轴微切口超声乳化白内障吸出术后角膜生物力学变化

目的　比较同轴微切口超声乳化白内障吸出术（ｐｈａｃｏｅｍｕｌｓｉｆｉｃａｔｉｏｎ，Ｐｈａｃｏ）及标准切口Ｐｈａｃｏ术后角膜生物力学的变化。方法　年龄相关性白内障患者３１２例（３１２眼）随机分成两组。其中研究组（２．２ｍｍ同轴微切口组）１５９例，对照组（３．０ｍｍ标准切口组）１５３例。记录两组术前数据，包括年龄、性别、裸眼视力（ｕｎｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＵＣ-ＶＡ）、最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＢＣＶＡ）、角膜滞后性（ｃｏｒｎｅａｌｈｙｓｔｅｒｅｔｉｅ，ＣＨ）、角膜阻力因数（ｃｏｒｎｅａｌｒｅｓｉｓｔａｎｃｅｆａｃｔｏｒ，ＣＲＦ）、Ｇｏｌｄｍａｎｎ相关眼压（ｇｏｌｄｍａｎｎｃｏｒｒｅｌａｔｅｄｉｎｔｒａｏｃｕｌａｒｐｒｅｓｓｕｒｅ，ＩＯＰｇ）、角膜补偿眼压（ｃｏｒｎｅａｌｃｏｍｐｅｎｓａｔｅｄＩＯＰ，ＩＯＰｃｃ）、中央角膜厚度（ｃｅｎｔｒａｌｃｏｒｎｅａｌｔｈｉｃｋｎｅｓｓ，ＣＣＴ）、角膜内皮细胞计数（ｅｎｄｏｔｈｅｌｉａｌｃｅｌｌｃｏｕｎｔ，ＥＣＣ）；术中数据包括累积能量复合参数（ｃｕｍｕｌａｔｉｖｅｄｉｓｓｉｐａｔｅｄｅｎｅｒｇｙ，ＣＤＥ）、手术时间。术后１ｄ、１周、２周、１个月复查，比较两组ＵＣＶＡ、ＢＣＶＡ、ＥＣＣ、ＣＣＴ、ＣＨ、ＩＯＰｇ、ＣＲＦ和ＩＯＰｃｃ。结果　术后１ｄ两组ＣＨ、ＣＲＦ均较术前明显降低，差异均有统计学意义（均为Ｐ＜０．０５）。术后１周，研究组ＣＨ、ＣＲＦ与术前差异均无统计学意义（均为Ｐ＞０．０５）；对照组ＣＨ、ＣＲＦ较术前降低，差异均有统计学意义（均为Ｐ＜０．０５）。术后２周，两组ＣＨ、ＣＲＦ均恢复至术前水平（均为Ｐ＞０．０５）；两组ＩＯＰｇ、ＩＯＰｃｃ仍高于术前（均为Ｐ＜０．０５），而低于术后１周（均为Ｐ＜０．０５）；两组ＣＣＴ恢复至术前水平（均为Ｐ＞０．０５）。术后４周，两组ＣＨ、ＣＲＦ、ＩＯＰｇ、ＩＯＰｃｃ、ＣＣＴ均恢复至术前水平（均为Ｐ＞０．０５）。术前，两组ＣＨ、ＣＲＦ与ＣＣＴ存在正相关性（研究组:ｒ１＝０．４３，ｒ２＝０．５２，对照组:ｒ１＝０．５６，ｒ２＝０．５３；均为Ｐ＜０．０５）。术后１ｄ，两组ＣＨ与ＣＣＴ均无相关性（ｒ１＝０．１３，ｒ２＝０．１０，均为Ｐ＞０．０５）。两组的ＣＲＦ值与ＣＣＴ在不同时相始终存在相关性（均为Ｐ＜０．０５）。两组间不同时相的ＣＨ与ＣＲＦ均存在正相关性（均为Ｐ＜０．０５）。结论　同轴微切口Ｐｈａｃｏ和标准切口Ｐｈａｃｏ均会改变角膜生物力学特征。同轴微切口Ｐｈａｃｏ比标准切口Ｐｈａｃｏ术后角膜生物力学特征恢复更快。

Corneal biomechanical changes after coaxial micro-incision phacoemulsification

Objective To research the changes of corneal biomechanics using ocular response analyzer after coaxial micro-incision phacoemulsification and standard coaxial phacoemulsification. Methods A total of 312 cases ( 312 eyes) with age-related cataract were included in this study and randomly divided into two groups, 159 cases in the study group ( 2. 2 mm coaxial micro-rncision group) , and 153 cases in the control group ( 3. 0 mm group) . The uncorrected visual acuity ( UCVA) .best corrected visual acuity ( BCVA) . cumulative dissipated energy ( CDE ) , corneal hysteretie ( CH) . comeal resistance factor ( CRF) , Goldmann correlated IOP ( IOPg) , corneal compensated IOP ( IOPcc) and central corneal thickness( CCT) at pre-operation and postoperative I day, I week.2 weeks,l month in two groups were recorded and compared. Results In both groups , there were significant decrease in CH and CRF at postoperative I day ( all P < 0. 05 ) . CH . CRF had no significant difference between postoperative I week and preoperation in the study group ( all P > 0. 05 ) . At postoperative I week . CH and CRF in the control group were lower than pre-operation, the difference was significant ( all P < 0. 05 ) . At postoperative 2 weeks. CH and CRF recovered to the preoperative levels in both groups( all P > 0. 05 ) ;IOPg and IOPcc of the two groups were still higher than preoperation ( all P < 0. 05 ) . but lower than that of postoperative I week ( all P < 0. 05 ) ; CCT of the two groups recovered to the preoperative level ( all P > 0. 05 ) . At postoperative 4 weeks , CH, CRF. CCT, IOPg, IOPcc were restored to the preoperative level ( all P > 0. 05 ) . In both groups,linear regression analysis showed significant correlations between preoperative CH, CRF and CCT ( In study group : ri = 0. 43 , r2 = 0. 52 ; In control group :ri =0. 56 . r7 = 0. 53 ; all P < 0. 05 ) . There was no sigruficant correlation between CH and CCT at postoperative I day in both groups ( ri = 0. 13 , r2 = 0. 10 , all P > 0. 05). There were significant correlations between CRF and CCT at different periods in both groups ( all P < 0. 05 ) . There were significant correlations between CH and CRH at different periods in both groups ( all P < 0. 05 ) . Conclusion The coaxial nucro-rncision phacoemulsification and standard coaxial phacoemulsification sigruficantly change the corneal biomechanics. The corneal biomechanics recover faster in coaxial micro-incision phacoemulsification.