Background In recent years,the relationship between transparent corneal incision and endophthalmitis is attracting more and more attention.Transparent corneal incision configuration become a research hotspot.Objective This study was to analyze dynamic architectural changes of 2.8 mm clear corneal incisions with different angles using anterior segment optical coherence tomography (AS-OCT) and safety.Methods A retrospective cases-control study was performed.Seventy-three eyes of 63 patients who received phacoemulsification combined with implantation of intraocular lens (IOL) were included in Ordos Central Hospital from January to October 2015.The patients were divided into incision ≤ 45° group and incision ＞45° group according to the angle of incision revealed by OCT.Thirty-eight eyes of 32 patients was in incision≤45° group and 35 eyes of 31 patients was in incision ＞ 45° group.Corneal incision quality was analyzed preoperative 1 day and postoperative 1 day,1 week and 1 month by AS-OCT.The corneal thickness at the incision,the length of the healed incision,the opening of the outer incision and inner incision and the detachment of the posterior elastic layer were observed.Written informed concent was obtained from each patient before surgery.Results The mean angle of the incisions in the incision ≤45 ° group was 31.6°-±5.4°,and that in the incision＞45° group was 54.3°±5.5°.The corneal thickness in the incision ≤45° group was significantly thicker than that in the incision＞45° group at postoperative 1 day and 1 week (t=5.96,P=0.00;t =4.69,P=0.00).The ratio of incision length without coaptation was higher in the incision ≤45° group than that in the incision＞45 ° group at postoperative 1 day,1 week and 1 month,respectively (Z =-5.14,P =0.00;Z =-5.46,P =0.00;Z =-3.52,P =0.00).The incidence of endothelial gaping was significantly lower in the incision ≤ 45° group than that in the incision＞45° group at 1 day,1 week and 1 month after surgery (x2 =6.88,P=0.01;x2 =14.87,P=0.00;x2 =9.07,P=0.00).The closure rates of outside incision were 100％ in both two groups.There were no statistically significant differences in Descemet detachment at 1 day,1 week and 1 month after surgery between two groups (x2 =0.15,P =0.70;x2 =1.29,P =0.36;x2 =0.02,P =0.89).Lip recession and contracture were observed in 3 eyes in the incision group.Conclusions At the early stage after phacoemulsification,when the intraocular pressure is changing constantly,small angle clear corneal incision appears to be a good closure and therefore is safer.%背景 近年来,白内障透明角膜切口和眼内炎的密切关系越来越受到重视,其中透明角膜切口的构型成为眼科医师研究的热点,因此有必要对透明角膜切口的角度进行进一步的研究. 目的 采用眼前节光相干断层扫描(AS-OCT)测量不同角度构建的2.8 mm透明角膜切口对白内障切口密闭性的影响.方法 采用回顾性病例对照研究.收集2015年1-10月在鄂尔多斯市中心医院行白内障超声乳化摘出联合人工晶状体(IOL)植入术的患者63例73眼,依据术后OCT测量的切口角度的不同分为切口≤45°组32例38眼和切口＞45°组31例35眼.各组患眼均行白内障超声乳化摘出联合折叠型IOL术,均做2.8mm透明角膜切口,术前1d及术后1d、1周及1个月应用AS-OCT对角膜切口区进行扫描,观察切口处的角膜厚度、切口未愈合长度、切口外口哆开或内口哆开及后弹力层脱离情况. 结果 切口≤45°组和切口＞45°组切口角度分别为31.6°±5.4°和54.3°±5.5°.术后1d和1周切口≤45°组切口处角膜较切口＞45°组明显增厚,差异均有统计学意义(t=5.96,P=0.00;t=4.69,P=0.00);术后1d、1周和1个月切口≤45°组切口未愈合比例均高于切口＞45°组,差异均有统计学意义(Z=-5.14,P=0.00;Z=-5.46,P=0.00;Z=-3.52,P=0.00);术后1d、1周和1个月切口≤45°组切口内口哆开的发生率明显低于切口＞45°组,差异均有统计学意义(x2=6.88,P=0.01;x2=14.87,P=0.00;x2=9.07,P=0.00);2个组间切口外口的闭合率均为100％;术后1d、1周和1个月切口≤45 °组和切口＞45°组后弹力层脱离的发生率差异均无统计学意义(均P＞0.05);术后1周在切口≤45°组中发现切口后唇后退、挛缩现象3眼.结论 白内障超声乳化术后早期眼压持续变动情况下,角度较小的切口安全性更好.
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