等长度巩膜隧道与透明角膜切口白内障超声乳化术的疗效比较

目的：探讨3.0mm巩膜隧道切口与3.0mm透明角膜切口下行白内障超声乳化术(Phaco)的临床效果。

方法：回顾性分析2015-01/2017-12我科收治的114例114眼白内障患者的临床资料，所有患者均采取Phaco治疗，作3.0mm巩膜隧道切口者纳入对照组(30例30眼)，作3.0mm透明角膜切口者纳入观察组(84例84眼)。比较术前和术后1wk，1、3mo时，两组患者角膜内皮细胞(corneal endothelial cell，CEC)密度、角膜散光度(corneal astigmatism，CA)、泪河高度(tear meniscus height，TMH)、裸眼视力(uncorrected visual acuity，UCVA)、泪液表皮生长因子(epidermal growth factor，EGF)变化，分析两组患者围手术期基本情况和术后3mo内并发症发生情况。

结果：术后1wk，1、3mo时，两组患者CEC密度水平均较术前显著下降，且观察组明显高于同期对照组，差异有统计学意义(均P<0.05)； 两组患者CA、TMH、EGF水平均较术前显著提升，且观察组明显低于同期对照组，差异有统计学意义(均P<0.05)； 两组患者UCVA水平(LogMAR值)均较术前有显著改善，且观察组明显优于同期对照组，差异有统计学意义(均P<0.05)； 观察组超声时间、累计释放能量、手术时间均明显少于对照组，差异有统计学意义(均P<0.05)。术后3mo内，观察组术后并发症总发生率明显低于对照组，差异有统计学意义(P<0.05)。

结论：采用3.0mm透明角膜切口行Phaco较3.0mm巩膜隧道切口更为适宜，有利于促进患者术后康复。

Effects of scleral tunnel incision or clear corneal incision with same length of phacoemulsification

AIM: To explore the differences of clinical effects between 3.0mm scleral tunnel incision and 3.0mm clear corneal incision of phacoemulsification(Phaco).

METHODS: The clinical data of 114 patients with cataract(114 eyes)were retrospectively analyzed. All patients were treated with Phaco, and patients with 3.0mm scleral tunnel incision were included in control group(n=30, 30 eyes), and patients with 3.0 mm clear corneal incision were included in observation group(n=84, 84 eyes). The changes of corneal endothelial cell(CEC)density, corneal astigmatism(CA), tear meniscus height(TMH), uncorrected visual acuity(UCVA)and tear epidermal growth factor(EGF)were compared before operation and at 1wk, 1mo and 3mo after operation, and the basic conditions during perioperative period and the occurrence of complications within 3mo after operation were analyzed in the two groups.

RESULTS:At 1wk, 1mo and 3mo after operation, the CEC density in the two groups was decreased significantly compared with that before operation, and the density in observation group was significantly higher than that in control group at the same time(all P<0.05). The levels of CA, TMH and EGF in the two groups were significantly higher than those before operation, and the levels in observation group were significantly lower than those in control group at the same time(all P<0.05). The levels of UCVA in the two groups were significantly decreased than those before operation, and the levels in observation group were significantly lower than those in control group at the same time(all P<0.05).The ultrasound time, cumulative release energy and operative time in observation group were significantly less than those in control group(all P<0.05). Within 3mo after operation, the total incidence rate of postoperative complications in observation group was significantly lower than that in control group(P<0.05).

CONCLUSION: The 3.0mm clear corneal incision Phaco is more appropriate than 3.0mm scleral tunnel incision, and the former one is conducive to promoting postoperative rehabilitation.