小切口非超声乳化白内障手术四种娩核方式的对比观察

目的探讨小切口非超声乳化白内障手术中4种不同娩核方式的特点及疗效。方法选白内障患者200例（200只眼）,随机分为4组,接受小切口非超声乳化白内障摘除联合人工晶状体植入术,分别通过黏弹剂娩核法、前房维持器娩核法、晶状体圈匙娩核法及前房内劈核法完成娩核过程,观察记录娩核时间、术后角膜水肿程度及术后视力。结果娩核时间（s）：黏弹剂组：11±2,维持器组：17±2,圈匙组：24±3,劈核组：63±5,经方差分析及最小显著性差异法（least-significant difference,LSD）检验,各组间均有统计学差异（P=0.00）;术后第1天角膜内皮水肿（≥2级）眼数（只）黏弹粘组：7（15%）,维持器组：10（20%）,圈匙组：19（40%）,劈核组：38（75%）,经检验,劈核组与黏弹粘组、维持器组以及圈匙组均存在统计学差异（Z=-7.477,-6.882,-4.294;P=0.00）,黏弹剂组与圈匙组存在统计学差异（Z=-3.281;P=0.001）。术后第1天视力≥0.3的眼数（只）：黏弹剂组：45（90%）,维持器组：43（85%）,圈匙组：33（65%）,劈核组：13（25%）,经检验,黏弹剂组优于圈匙组和劈核组（P=0.00）,维持器组和圈匙组均优于劈核组（P=0.00）。结论在临床应用中,4种娩核方式各有特点。其中,黏弹剂娩核法、前房维持器娩核法因其操作简便,损伤小,术后视力恢复良好,值得临床推广。

Comparison of four different nucleus delivery methods in small incision cataract surgery

Objective To contrast clinical efficacy of four different nucleus delivery methods in small incision cataract surgery.Methods 200 patients(200 eyes) with senile cataract under went cataract surgery.These patients were divided into four groups(50 eyes each group) randomly: sodium hyaluronate irrigation group、anterior chamber maintainer group、lens loop extracting nucleus group and manual fragmentation group.Visual acuity、average extracting nucleus time and corneal edema were observed.Results The average extracting nucleus time:sodium hyaluronate irrigation group:11’±2’’,anterior chamber maintainer group:17"±2’’,lens loop extracting nucleus group:24’’±3’’,and manual fragmentation group:63’’±5’’.There was obvious difference between each other group(P=0.00).Clinical corneal edema one day after operation: sodium hyaluronate irrigation group:7cases(15%),anterior chamber maintainer group :10 cases(20%),lens loop extracting nucleus group:19 cases(40%),and manual fragmentation group:38 cases(75%).There was obvious difference between manual fragmentation group and the others(Z=-7.477,-6.882,-4.294;P=0.00).There was difference between sodium hyaluronate irrigation group and lens loop extracting nucleus group(Z=-3.281;P=0.001).Visual acuity≥0.3 one day after operation: sodium hyaluronate irrigation group:45 cases(90%),anterior chamber maintainer group :43 cases(85%),lens loop extracting nucleus group:33 cases(65%),and manual fragmentation group:13 cases(25%).There was obvious difference between sodium hyaluronate irrigation group and manual fragmentation group、anterior chamber maintainer group(P=0.00).There was obvious difference between manual fragmentation group and lens loop extracting nucleus group、anterior chamber maintainer group(P=0.00).Conclusion Each method has its characteristics in clinical application.Sodium hyaluronate irrigation and anterior chamber maintainer can be applied extensively due to simple operation,less injury and better visual acuity.