不同术式对高度近视眼白内障患者角膜水肿及影响因素的Logistic分析

目的　观察小切口白内障摘出并人工晶状体植入术与超声乳化白内障摘出并人工晶状体植入术后角膜水肿的发生率及影响因素。方法　收集２０１３年１月至２０１５年１０月我院收治高度近视眼白内障手术患者２９２例（３３５眼），随机分为对照组（１４０例１５９眼）和试验组（１５２例１７６眼）。对照组采用小切口白内障摘出并人工晶状体植入术，试验组采用超声乳化白内障摘出并人工晶状体植入术。观察对照组和试验组术后１ｄ、７ｄ角膜水肿情况及角膜容积，并应用多元Ｌｏｇｉｓｔｉｃ回归分析术后角膜水肿发生的危险因素。结果　角膜水肿情况显示，术后１ｄ、７ｄ角膜水肿发生率对照组（３２．７％、３．１％）与试验组（３５．８％、５．１％）比较差异均无统计学意义（χ２＝０．３５４、０．８０９，Ｐ＝０．５５２、０．３６８）。核硬度分级显示，对照组核硬度≤Ⅲ级患者术后１ｄ和７ｄ角膜水肿发生率（２７．９％、１．２％）与试验组（２１．０％、１．０％）比较差异均无统计学意义（χ２ ＝１．２０３、０．０１２，Ｐ＝０．２７３、０．９１５）；对照组核硬度≥Ⅳ级患者术后１ｄ角膜水肿发生率（３８．４％）明显低于试验组（５５．３％），差异有统计学意义（χ２＝４．２７３，Ｐ＝０．０３９）。角膜容积显示，两组患者术后１ｄ的ＣＶ３、ＣＶ５和ＣＶ７明显高于术前（均为Ｐ＜０．０５）；对照组术后７ｄ的ＣＶ３、ＣＶ５和ＣＶ７明显低于试验组，差异均有统计学意义（ｔ＝２．６４５、２．８９６、３．２６５，Ｐ＝０．０２３、０．０１９、０．０１４）。单因素分析显示，年龄、切口靠前、灌注压力高时间长、原角膜有损伤、后弹力层撕脱、晶状体核硬度是影响术后角膜水肿发生的因素（均为Ｐ＜０．０５）。多元Ｌｏｇｉｓｔｉｃ回归分析显示，切口靠前、灌注压力高时间长、后弹力层撕脱、核硬度Ⅲ ～Ⅳ级、核硬度Ⅴ级与术后角膜水肿发生有关。结论　核硬度≥Ⅳ级患者小切口白内障摘出术较超声乳化白内障摘出术治疗效果好，切口靠前、灌注压力高时间长、后弹力层撕脱、核硬度Ⅲ ～Ⅳ级、核硬度Ⅴ级可能是术后角膜水肿发生的危险因素。

Different operative methods for high myopia cataract patients with corneal edema and Logistic analysis of influencing factors

Objective To observe the incidence of corneal edema and its influencing factors after cataract extraction of either small incision or phacoemulsification with intraocular lens implantation. Methods Cataract surgery patients of 292 cases ( 335 eyes) were collected from January 2013 to October 2015 in our hospital. They were randomly divided into the control group ( 140 cases of 159 eyes) and the experimental group ( 152 cases of 176 eyes). The control group received cataract extraction with small incision combined with intraocular lens implantation. and experimental group received phacoemulsification cataract extraction combined with intraocular lens implantation. Corneal edema and corneal volume were observed at I day and 7 days after operation in control group and experimental group , and the risk factors of corneal edema after operation were analyzed by multivariate Logistic regression analysis. Results The corneal edema incidence in the control group were 32. 7% .3. 1% at l day and 7 days, and the experimental group were 35. 8% .5. 1% , respectively , there was no statistically sigruficant difference between two groups (X2 = 0. 354 , 0. 809 ;P = 0. 552 , 0. 368 ) . Nuclear hardness classification showed that . the corneal edema incidence in patients with nuclear hardness less than or equal to grade JII at I day and 7 days in the control group were 27. g% ,1. 2% , and the experimental group were 21. 0% . 1. 0% , respectively, there was no statistically significant difference between two groups (X2 = 1. 203 .0. 012 ;P = 0. 273 , 0. 915 ) . The corneal edema incidence in patients with nuclear hardness more than or equal to grade lV in the control group ( 38. 4% ) was obviously lower than that in the experimental group (55. 3% ) , the difference was statistically significant (X2 = 4. 273 ,P = 0. 039) . Corneal volume ( CV) showed that , CV3 . CV5 and CV7 at I day after operation in two groups were significantly higher than preoperative ( all P < 0. 05 ) . and CV3 . CV5 and CV7 in the control group at 7 days after operation were sigruficantly lower than those in the experimental group , the differences were statistically significant ( t = 2. 645 . 2. 896 , 3. 265 ;P = 0. 023 . 0. 019 . 0. 014 ) . Univariate analysis showed that age , incision in front , high perfusion pressure for a long time , corneal injury , after elastic layer avulsion .lens nucleus hardness were postoperative influencing factors of corneal edema ( all P < 0 . 05 ) . Multivariate logistic regression analysis showed that incision in front ,high perfusion pressure for a long time , after elastic layer avulsion ,nuclear hardness grade III to lV .nuclear hardness grade V were related to the occurrence of corneal edema after surgery( all P < 0. 05 ) . Conclusion The patients with nuclear hardness more than or equal to grade lV with small incision cataract surgery have better efficacy than phacoemulsification , and incision in front ,high perfusion pressure for a long time , after elastic layer avulsion , nuclear hardness grade JII to lV , nuclear hardness grade V may be the risk factors for postoperative corneal edema.