不同超声能量模式在硬核白内障超声乳化吸除术中的应用观察

目的 探讨连续、脉冲、爆破3种超声能量模式在硬核白内障超声乳化吸除术中应用.方法 选取晶状体核硬度≥Ⅲ级(LOCS Ⅱ分级标准)的老年性白内障患者185例(212只眼),随机分为3组,分别采用连续、脉冲、爆破3种超声能量模式行超声乳化白内障吸出联合后房型人工晶状体植入术,观察术中实际超声过程中平衡液的用量、超声乳化晶状体核的实际超声能量(actual power,AP)、有效超声时间(effect phaco time,EPT),和累积能量复合参数(accumulated energy complex parameter,AECP),比较术后角膜内皮细胞丢失率及角膜切口热灼伤状况.结果 爆破组实际超声过程中平衡液的用量远远低于脉冲及连续组,差异显著有统计学意义(P＜0.05).爆破组AP与脉冲组相比无统计学意义(P＞0.05),EPT、AECP明显低于脉冲组(P＜0.05).AP、EPT、AECP均明显低于连续组(P＜0.05).术后1周爆破组角膜内皮细胞密度高于脉冲及连续组,角膜内皮细胞丢失率明显低于脉冲及连续组,差异有统计学意义(P＜0.05).全部3组病人术后均无角膜切口热灼伤.结论 爆破模式在处理硬核白内障时可显著减少实际超声中平衡液的使用量,降低术中EPT和累计超声能量,从而减轻对眼内组织的损伤,提高了手术效率,是一种更为优化利用能量的模式.

Application of different mode in phacoemulsification of hard nucleus cataract

Objective To investigate the application of continuous,pulse and burst modes in phacoemulsification of hard nucleus cataract.Methods 212 eyes(185 patients)of hard nucleus cataract(LOCS Ⅱ criteria≥Ⅲ degree)were randomly divided into 3 groups(continuous group,pulse group and burst group).Various phaco modes were used The differences in amount of balanced salt solution use throughout phaco time,actual power(AP),the effect phaco time(EPT),and accumulated energy(AECP),endothefial cell loss and corneal incision burn were compared among the three groups.Results The amount of balanced salt solution use throughout phaco time of the burst group was far less in comparision to those of the other two groups.The difference was statistically significant (P＜0.05).There was no statistically significant difference in actual power between burst and pulse group(P＞0.05).The mean EPT and AECP of burst group were statistically lower than those of the pulse group(P＜0.05).AP,EPT and AECP of burst group were significantly much lower than those of the continuous group(P＜0.05).The mean density of endothelial cell of burst mode was much higher than those of continuous and pulse group 1 week after surgery and endothelial cell loss rate was significantly lower than those of the two other groups(P＜0.05).No serious corneal incision burn occurred in each of the three groups.Conclusion The use of burst mode in hard nucleus cataract reduces significantly the amount of balanced salt solution use throughout phaco time and the amount of accumulated energy,which causes diminished injury to surrounding ocular structures and improved surgical efficiency.Burst mode is advised for its efficiency in energy utilization in phacoemulsification.