飞秒激光超声乳化白内障吸除术与2.2 mm同轴微切口超声乳化白内障吸除术早期临床效果对比

目的对比飞秒激光超声乳化白内障吸除术与传统2.2 mm同轴微切口超声乳化白内障吸除术早期临床效果，探讨飞秒激光超声乳化白内障吸除术的有效性及安全性。方法前瞻性队列研究。选择2013年12月至2014年5月在山西省眼科医院行超声乳化白内障吸除联合人工晶状体（IOL）植入术的年龄相关性白内障患者87例（114眼），根据手术方式分为2组，飞秒激光超声乳化手术组（FLACS组）44例（60眼），2.2 mm同轴微切口超声乳化白内障吸除术组（传统组）43例（54眼）。FLACS组利用LenSx飞秒设备，在前节光学相干断层扫描（OCT）的监测下行前囊膜环形切开、碎核、制作2.2 mm透明角膜切口。传统组手工制作2.2 mm透明角膜切口，连续环形撕囊。根据患者需求，选择植入非球面IOL（SN60WF）或多焦点IOL（SN6AD1），对比2种手术方式术后早期远视力、中央角膜厚度、角膜内皮细胞计数、超声能量的使用情况及术中术后并发症的差异。采用秩和检验、独立样本t检验及配对t检验进行数据分析。结果2组术后1个月远UCVA及BCVA差异无统计学意义；FLACS组角膜内皮细胞密度丢失率低于传统组，但差异无统计学意义；FLACS组术后中央角膜厚度恢复早于传统组。FLACS组超声时间较传统组减少30%，累计释放能量较传统组减少49%，2组差异有统计学意义（t=-2.739，P＜0.01；Z=-2.979，P＜0.01）。飞秒激光制作的透明角膜切口，78%可以顺利用分离器分开，13%主切口需要用角膜刀手工穿刺，7%侧切口需要角膜刀穿刺，2%发生主切口倾斜。飞秒激光进行前囊膜切开，93%顺利完成，7%发生不连续撕囊，需要手工调整，撕开部分囊膜，使之完全游离。结论飞秒激光超声乳化白内障吸除术与传统2.2 mm同轴微切口超声乳化白内障吸除术相比，其使用的超声能量大大减少，术后早期角膜组织恢复更快，手术更加安全有效。

Early clinical experience in femtosecond laser-assisted cataract surgery compared to conventional cataract surgery

ObjectiveTo investigate the safety and efficacy of femtosecond laser-assisted cataract surgery compared to conventional cataract surgery. MethodsEighty-seven patients （114 eyes） were enrolled in this prospective cohert study between December 2013 and May 2014 in Shanxi Eye Hospital. Forty-four patients （60 eyes） underwent femtosecond laser-assisted cataract surgery. Forty-three patients （54 eyes） underwent 2.2 mm coaxial microincision cataract surgery. Femtosecond laser-assisted cataract surgery involved anterior capsulotomy， corneal incision and lens fragmentation based on optical coherence tomography-guided treatment mapping. An aspheric intraocular lens （SN60WF） or a multifocal intraocular lens （SN6AD1） was implanted based on the patient′s preference. Intraoperative complication rates and phaco energy parameters were recorded. Visual acuity， central corneal thickness and corneal endothelial cell loss were analyzed and the measurements were compared between the two groups. ResultsThere were no statistically significant differences in visual acuity and best corrected visual acuity （BCVA）. The reduction in the mean number of endothelial cells was lower in the femtosecond laser-assisted cataract surgery group， but the difference was not significant. U/S total time was reduced to 30% compared to the conventional cataract surgery group （t=-2.739， P＜0.01）. Cumulative dissipated energy （CDE） was reduced 49% （Z=-2.979， P＜0.01）. In the femtosecond laser-assisted cataract surgery group， an incision was easily opened in 78%； incisions for the remaining patients were more difficult to perform. 93% of the capsule buttons were free floating and 7% were incomplete and a manual capsulorrhexis was required to complete the capsulotomy. ConclusionFemtosecond laser capsulotomy and lens fragmentation significantly reduce ultrasound use compared to conventional surgery. The new surgery appears to be safer and more efficient than conventional cataract surgery in the short term postoperatively.