两种粘弹剂对小切口白内障术后眼压的影响

目的 评价分散粘弹剂羟丙甲基纤维素(20g·L~(-1))及硫酸软骨素钠-透明质酸钠(30g·L~(-1))对小切口双侧白内障摘出术后眼压的影响。方法 老年性白内障患者20例40眼,全部进行小切口双侧白内障手术。于一眼白内障手术时随机选择1种粘弹剂,另眼时给予另1种粘弹剂。手术采用角膜缘反眉弓切口,长5mm,切开后环形撕囊,水分离,碎核刀碎核,晶状体圈娩出晶状体核,冲洗皮质。然后植入后房型聚甲基丙烯酸甲酯人工晶状体,不缝合。术前测眼压,术后6、24h及1周各测眼压1次。结果 术后6h羟丙甲基纤维素组眼压升高(3.8±5.0)mmHg(1kPa=7.5mmHg,P<0.001),硫酸软骨素钠-透明质酸钠组升高(7.7±7.6)mmHg(P<0.001),硫酸软骨素钠-透明质酸钠组眼压升高比羟丙甲基纤维素组明显(P=0.008)。眼压>30mmHg羟丙甲基纤维素组1眼、硫酸软骨素钠-透明质酸钠组5眼(P<0.05)。术后24h及术后1周平均眼内压无明显差异。结论 研究结果表明,硫酸软骨素钠-透明质酸钠在小切口白内障早期引起的眼压升高比羟丙甲基纤维素更明显。

Comparison of effects of two dispersive viscoelastic agents on intraocular pressure after small incision cataract surgery

Objective To evaluate the effects of the dispertive viscoelastic agents hydroxypropyl methylcellulose (HPMC, 20g L-1) and sodium chondroitin sulfate-sodium hyaluronate (SCS-SH, 30g L-1) on postoperative intraocular pressure (IOP) after bilateral small incision cataract surgery. Methods Forty eyes of 20 consecutive patients in both eyes scheduled for bilateral small incision cataract surgery. They were randomly assigned to receive HPMC or SCS-SH during cataract surgery of the first eye. The other eye was operated afterwards and received the other viscoelastic agent. Cataract surgery was performed with a 5 mm sutureless reverse superciliary arch limbal incision and implantation of a pasterior chamber type polymethylmethacrylate intraocular lens. The IOP was measured before operation in 6,24 hours and 1 week after operation. Results At 6 hours after surgery the mean IOP increased by (3.8+5.0)mmHg ( 1 kPa = 7.5mmHg) in the HPMC group(P<0. 001) and by (7. 7 + 7.6) mmHg in the SCS-SH group (P<0. 001). The increase was significantly higher in the SCS-SH group than in the HPMC group ( P = 0. 008). IOP spikes of 30 mmHg or more occured in one eye in the HPMC group and in five eyes in the SCS-SH group (P<0. 05); The mean IOP was not statistically different 24 hours and 1 week after operation. Conclusion Our results indicate that SCS-SH causes a significantly higher IOP increase and significantly more IOP spikes than HPMC in the early period after small incision cataract surgery.