不同灌注套管与超声乳化针头配套对白内障超声乳化切口的影响

摘要

目的：探讨通过改变灌注套管与超声乳化针头的配套，缩小白内障超声乳化手术切口，减少术源性散光。方法：选取年龄相关性白内障患者98例（120眼），年龄52～80岁，晶状体混浊2-3级，按随机数字表法分为2组，A 组46例（60眼），B组52例（60眼）。A组将（美国Bausch＆Lomb公司） Stellaris超声乳化仪的3.2mm超声乳化针头更换为1.8mm的针头，但仍用原3.2mm灌注套管，将手术切口减小到2.2 mm行同轴微切口白内障超声乳化联合人工晶状体植入术，B组行3.2 mm 传统同轴超声乳化联合人工晶状体植入术。术中记录超声乳化时间和能量，术后第1天、第1周和第1个月观察随访，记录术后的裸眼视力、散光改变、超声乳化时间及能量，并对所得数据进行分析。结果：术前与术后相比，角膜散光均有不同程度改变；术后第1天、第1周和第1个月，A组角膜散光均小于B组，差异有统计学意义（P＜0．05）。视力变化：术后第1周，A组裸眼视力好于B组，两组之间存在统计学差异（P＜0．05），术后第1天和第1个月视力无统计学差异（P＞0．05）。平均超声乳化时间、有效超声乳化时间、平均超声乳化能量均无统计学差异（P＞0．05）。结论：通过改变灌注套管与超声乳化针头的配套即可将传统3.2mm手术切口缩小至2.2 mm ，既满足人工晶体植入的要求，又有效减少术源性散光，早期视力恢复快，前房密闭稳定，手术安全可靠。%Objective:To observe the clinical outcome of phacoemulsification through 1.8 mm coaxial microincision and compare it with that of phacoemulsification through 3.2 mm coaxial incision. Methods: Sixty eyes of 46 patients with age-related cataract (grade Ⅲ lens opacity) at the age of 52 to 80 years were randomly divided into group A (n=60) and group B (n=60). Eyes in group A underwent phacoemulsification through 1.8 mm coaxial microincision and artificial lens implantation while those in group B underwent phacoemulsification through 3.2 mm coaxial incision and artificial lens implantation. Phaco power and time were recorded during operation. The patients were followed up in 1 day,1 week and 1 month after operation,during which corneal astigmatism,visual acuity of naked eyes, corneal endothelial cell count and complications were recorded. Results:No significant difference was found in the average phaco time(APT) ,effective phaco time(EPT) and average phaco power(AVE) between the two groups during operation(P>0.05) . The visual acuity of naked eyes was better in group A than in group B in the first week after operation(P<0.05) with no significant difference between the two groups on 1 day and in the first month after operation (P>0.05) . The surgical astigmatism in group A was less than that of group B in every time point (P<0.05).No statistically significant difference was found in the corneal endothelial cell count between the two groups in every time position after operation (P>0.05). Conclusion:Phacoemulsification through 1.8 mm coaxial microincision can reduce thecorneal astigmatism,rapidly restore the early.