微脉冲超声能量模式在白内障超声乳化吸出术中的应用效果

目的　观察微脉冲超声能量模式在白内障超声乳化吸出术中应用的临床效果。方法　选择2018年9月至2019年2月于我院就诊并行白内障超声乳化吸出联合人工晶状体植入术的患者146例（178眼）进行前瞻性随机对照研究。将患者分为2组，微脉冲模式组（A组，88眼）、脉冲模式组（B组，90眼）。再根据Emery核硬度分级标准将2组患者各分为1（Ⅱ级核，59眼）、2（Ⅲ级核，86眼）、3（Ⅳ级核，33眼）小组。记录术前视力、白内障核硬度分级；比较2组术中所用的实际超声能量（actual power，AP）、有效超声时间(effective phaco time，EPT)；术后1 d和7 d最佳矫正视力（best corrected visual acuity，BCVA）；术后1 d、7 d和30 d的中央区角膜内皮细胞密度（corneal endothelial cell density，CECD）、六角形细胞比率和术后30 d的角膜内皮细胞损失率。结果　A组和B组的AP、EPT比较:各组间比较AP均减少、EPT均缩短。A1、B1组比较差异无统计学意义(P＞0.05)；A2、B2组及A3、B3组之间比较差异均有统计学意义(均为P＜0.05)。中央区CECD、PHC比较:术后1 d、7 d、30 d分别与术前比较，差异均有统计学意义（均为P＜0.05）。中央区CECD术后不同时间点比较:A1组与B1组差异均无统计学意义（均为P＞0.05），A2组与B2组、A3组与B3组之间差异均有统计学意义（均为P＜0.05）。术后1 d、7 d A3组与B3组PHC比较差异均有统计学意义（均为P＜0.05），术后30 d各组间比较差异均无统计学意义（均为P＞0.05）。角膜内皮细胞损失率比较:术后30 d A组与B组差异有统计学意义（P＜0.05）。术后BCVA:术后1 d、7 d A组及B组比较差异有统计学意义(P＜0.05)，而术后30 d A、B组差异无统计学意义(P＞0.05)。结论　微脉冲超声能量模式可使白内障超声乳化吸出术的超声时间缩短、超声能量降低，可减少对眼内组织特别是对角膜内皮细胞的损伤，其安全性、有效性值得在临床上推广使用。

Application effect of micro-pulse ultrasonic energy mode in phacoemulsification

Objective　To evaluate the clinical effect of applying micro-pulse ultrasonic energy mode in phacoemulsification.Methods　A prospective randomized study was conducted in 146 patients (178 eyes) who underwent phacoemulsification combined with intraocular lens implantation from September，2018 to February，2019.The patients were registered into two groups:micro-pulse mode group (Group A，88 eyes) and pulse mode group (Group B，90 eyes).Each group was divided into 3 subgroups according to Emery nuclear hardness grading standard:subgroup 1（Class Ⅱ nuclear，59 eyes)，subgroup 2（Class Ⅲ nuclear，86 eyes) and subgroup 3 (Class Ⅳ nuclear，33 eyes).Preoperative measurements included visual acuity and cataract nuclear hardness grade；intraoperative measurements included actual power (AP) and effective phaco time (EPT)；postoperative measurements included best correct visual acuity (BCVA) 1 day and 7 days after operation；postoperative 1-day，7-day and 30-day central corneal endothelial cell density (CECD)，percentage of hexagon cells (PHC) and postoperative 30-day loss of corneal endothelial cells.Results　Comparison of AP and EPT between Group A and Group B:AP was reduced and EPT was shortened in comparison between groups.There was no statistically significant difference between GroupA1 and Group B1 (all P>0.05)；the differences between Group A2，Group B2，Group A3 and Group B3 were statistically significant (all P<0.05).Comparison of CECD and PHC in central region:postoperative 1-day，7-day and 30-day after surgery were compared with those before surgery，respectively，and the differences were statistically significant (all P<0.05).Comparison of CECD at different time after surgery:there was no statistically significant difference between Group A1 and Group B1 (all P>0.05)，but there were statistically significant differences between Group A2 and GroupB2，GroupA3 and GroupB3 (all P<0.05)；differences in postoperative 1-day，7-day PHC of GroupA3 and GroupB3 are statistically significant (all P<0.05)，but difference in postoperative 30-day PHC between groups were not statistically significant (all P>0.05).Comparison of the loss rate of corneal endothelial cells:the loss rate of corneal endothelial cells 30 days after surgery was statistically significant between Group A and Group B (P<0.05).Postoperative BCVA:there was a statistically significant difference between the two groups 1 day and 7 days after surgery (P<0.05)，while there was no statistically significant difference between the two groups 30 days after surgery (P>0.05).Conclusion　Micro-pulse ultrasonic energy mode can shorten the ultrasonic time，reduce the ultrasonic energy and reduce the damage to the intraocular tissues.Therefore its safety and effectiveness are worthy of clinical application.