目的 比较并分析小切口非超声乳化白内障摘出术与超声乳化白内障摘出术在西藏高海拔地区的复明效果和安全性,为西藏自治区白内障复明手术术式选择提供参考依据.方法 采用前瞻性队列研究方法,纳入2016年7-8月在西藏自治区藏医院拟接受年龄相关性白内障手术的藏族白内障患者80例80眼,按照手术方法不同分为小切口非超声乳化白内障摘出联合人工晶状体(IOL)植入术组(小切口组)和超声乳化白内障摘出联合IOL植入术组(超声乳化组),每组40例40眼.对2个组患者术前及术后1d、5d不同裸眼视力的眼数分布进行观察和比较,并比较2个组间术眼术后并发症发生率. 结果 术前2个组患者性别、年龄、术前视力、晶状体核硬度分级(Emery分级)比较,差异均无统计学意义(均P＞0.05).术后1d和5d,2个组间不同视力眼数分布比较,差异均无统计学意义(均P＞0.05).术后5d,小切口组与超声乳化组Ⅱ级和Ⅲ级核术眼不同视力眼数分布比较,差异均无统计学意义(Z=0.503,P=0.478;Z=0.952,P=0.329),Ⅳ级核术眼小切口组视力≥0.5的眼数多于超声乳化组,差异有统计学意义(Z=4.501,P=0.034).术后1d,小切口组术眼术后一过性高眼压眼数多于超声乳化组,用药后1d内眼压均恢复至正常水平. 结论 小切口非超声乳化白内障摘出联合IOL植入术与超声乳化白内障摘出联合IOL植入术视力预后接近,可作为西藏自治区基层医疗机构开展白内障复明的首选术式.%Objective To compare and analyze the visual outcome and safety of phacoemulsification with small incision non-phacoemulsification for cataract and provide a reference for the selection of surgery methods in Tibet.Methods A prospective cohort study was performed.Eighty eyes of 80 consecutive patients with age-related cataract were included in Titet Autonomous Region Tibetan Tradition Medicine Hospital from July to August 2016.The eyes were assigned to non-phacoemulsification extracapsular cataract extraction with small incision combined with intraocular lens (IOL) implantation group (small incision group) and phacoemulsification extracapsular cataract extraction combined with IOL implantation group (phacoemulsification group),with 40 eyes for each group.The uncorrected visual outcome and complications were compared between the two groups after surgery.Results There were no significant differences in gender,age,preoperative visual acuity,and lens nuclear hardness between the two groups (all at P＞0.05).The eyes in various post-operative uncorrected visual acuity outcome was not significantly different 1 day and 5 days after surgery between the two groups (both at P＞0.05).In the fifth day after surgery,the eye number in various post-operative uncorrected visual acuity outcome was not significantly different in the eyes with grade Ⅱ and Ⅲ nuclei between the two groups (Z =0.503,P =0.478;Z =0.952,P =0.329).The eye number of acuity ≥0.5 in the small incision group was significantly more than that in the phacoemulsification group in the eyes with grade Ⅳ nuclei (Z =4.501,P =0.034).The eye number with post-operative transiently ocular hypertension was increased in small incision group compared with phacoemulsification group.Conclusions Non-phacoemulsification surgery with small incision has comparable visual outcome with phacoemulsification surgery,and small incision nonphacoemulsification surgery combined with IOL implantation can serve as the preferred surgical method in basic level medical institutions of Tibet.
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