T形钩预劈核联合囊膜精细处理技术在高度近视合并白内障术中的应用

目的:探讨T形钩预劈核联合囊膜精细处理技术治疗高度近视合并白内障的临床疗效。方法:选取2016-03/2019-02期间在河北省眼科医院就诊的合并高度近视的白内障患者56例80眼,随机进行分组,A组患者40眼行白内障超声乳化联合T形钩预劈核及囊膜精细处理手术。B组患者40眼行单纯白内障超声乳化术。比较两组患者术中超声累积释放能量,术后随访6mo以上,观察最佳矫正视力(BCVA)、前囊口收缩变化量、后囊膜混浊程度、人工晶状体居中性及手术并发症情况。结果:A组患者术中超声累积释放能量少于B组(12.23±3.61 vs 20.46±4.61,P<0.01)。术后6mo,A组患者BCVA优于B组(Z=5.328,P=0.002),前囊口收缩变化量、人工晶状体偏中心量(0.18±0.14、0.02±0.007mm)小于B组(0.82±0.23、0.65±0.240mm)(均P<0.05),且A组患者均可见后囊膜中央3mm大小圆孔,视轴区保持透明,而B组患者中13眼(32%)出现后囊膜中央区混浊。A组患者未出现术中后囊膜意外破裂及术后视网膜脱离情况,B组患者术中发生后囊膜意外破裂2眼(5%),术后视网膜脱离1眼(2%)。结论:采用T形钩预劈核联合囊膜精细处理技术治疗合并高度近视的白内障可减少术中超声能量的使用,降低后囊膜破裂的风险,有效避免后发性白内障的发生,可以取得满意的临床疗效。

Application of T-hook pre-chopping combined with capsule fine treatment technology in cataract surgery for high myopia

AIM: To explore the clinical efficacy of the T-hook pre-chopping combined with capsule fine treatment technology for patients with high myopia and cataract.

METHODS: From March 2016 to February 2019, 56 cases(80 eyes)of cataract patients with high myopia were treated in cataract department of Hebei Province Eye Hospital. They were randomly divided into A and B groups, 40 eyes in each group. Group A underwent T-hook pre-chopping combined with fine capsular treatment. Cataract phacoemulsification combined with intraocular lens implantation was purely performed in group B. We compared the cumulative release energy of ultrasound during operation between the two groups. We also observed the best corrected visual acuity(BCVA), the amount of contraction of the anterior capsule, the degree of posterior capsule opacification, intraocular lens neutrality and complications for more than 6mo.

RESULTS: The cumulative release energy of ultrasound in group A was less than that in group B(12.23±3.61 vs 20.46±4.61, P<0.01). The best corrected visual acuity of group A was better than that of group B at 6mo after operation(Z=5.328, P=0.002). The changes of anterior capsular contraction and intraocular lens decentration(0.18±0.14, 0.02±0.007mm)were less than those of group B(0.82±0.23, 0.65±0.240mm)(P<0.05). In group A, there were 3mm round holes in the center of the posterior capsule, and the optic axis area remained transparent, while in group B, 13 eyes(32%)had turbid central area of the posterior capsule. In group A, there was no intraoperative posterior capsule rupture or postoperative retinal detachment. In group B, there were 2 eyes(5%)with intraoperative posterior capsule rupture and 1 eye(2%)with postoperative retinal detachment.

CONCLUSION: We used T-hook pre-chopping combined with capsule fine treatment technology to treat cataract with high myopia, which could reduce the use of ultrasound energy during operation, reduce the risk of posterior capsule rupture, effectively avoid the occurrence of posterior cataract, and achieve satisfactory clinical effect.