摘要：
Objective To investigate the clinical effect and safety of two-step capsulorhexis in phacoemulsification with intraocular lens (IOL) implantation for hypermature cataract.Methods A non-randomized controlled clinical trial was carried out in Huaibei People's Hospital.Forty eyes of 40 patients with hypermature cataracts were enrolled from January 2016 to March 2017.The patients were divided into 2 groups according to different capsulorhexis.Two-step curvilineal capsulorhexis was used during the phacoemulsification with IOL implantation in 20 eyes of the 20 patients in the two-step capsulorhexis group (to complete a 4 mm-diameter capsulorhexis with the ripping forceps firstly and then extented the capsulorhexis diameter until 5-6 mm),and conventional curvilineal capsulorhexis was used during the phacoemulsification with IOL implantation in 20 eyes of the 20 patients in the conventional capsulorhexis group.The demography was matched between the two groups and the same foldable IOLs were used in the surgery.The uncorrected visual acuity,successful rate of capsulorhexis,intra-and post-operative complications were compared.Results The postoperative visual acuity was considerably improved both in the two groups after surgery.The UCVA in postoperative 1 day and 3 days were 4.70±0.09 and 4.70±0.08 in the two-step capsulorhexis group,which were significantly better than 4.60 ± 0.08 and 4.60 ± 0.08 in the conventional capsulorhexis group (both at P＜0.05),and no significant differences were found in the UCVA in postoperative 7 days,1 month and 3 months between the two groups (all at P＞0.05).The successful rate of capsulorhexis in the two-step capsulorhexis group was 100％ (20/20),which was significantly higher than 80％ (16/20) in the control group (x2 =4.44,P＜0.05).Posterior capsule rupture occurred in 4 eyes in the conventional capsulorhexis group,and no posterior capsule rupture was found in the two-step capsulorhexis group (x2=4.44,P＜0.05).The incidence rates of corneal edema in postoperative 1 day and 3 days were 40％ and 45％ in the conventional capsulorhexis group,which were significantly higher than 10％ and 15％ in the two-step capsulorhexis group (x2 =4.80,4.19,both at P＜0.05),and the corneas were clear in 7 days after surgery.No significant differences were found in intraocular pressure between groups and various time points (Fgroup =0.091,P =0.765;Ftime =7.048,P ＞ 0.05).Conclusions Two-step capsulorhexis during phacoemulsification with IOL implantation for hypermature cataract is safe and effective in improving the successful rate of continuous curvilineal capsulorrhexis,reducing intra-operative and postoperative complications,and it is beneficial to the recovery of postoperative visual acuity.%目的 探讨二次撕囊技术在过熟期白内障超声乳化手术中的临床效果及安全性.方法 采用非随机对照研究方法,纳入2016年1月至2017年3月在淮北市人民医院拟行白内障超声乳化摘出联合人工晶状体(IOL)植入术的过熟期白内障患者40例40眼,根据术中拟用撕囊方式的不同将术眼分成2个组.二次撕囊组共20例20眼,在白内障超声乳化摘出术中采用二次撕囊技术,即先用撕囊镊完成4 mm的小圆形撕囊,待超声乳化及IOL植入后再扩大撕囊范围至5～6 mm;常规撕囊组共20例20眼,在白内障超声乳化摘出术中采用常规撕囊法完成撕囊操作.2个组间患者人口基线特征匹配,术眼均采用同一规格的折叠式IOL.比较2个组间术眼术后裸眼视力(UCVA)、撕囊成功率以及术中和术后并发症情况. 结果 2个组术后视力均较术前明显提高,术后1d、3d二次撕囊组术眼UCVA分别为4.70±0.09和4.70±0.08,明显优于常规撕囊组的4.60±0.08和4.60±0.08,差异均有统计学意义(均P＜0.05),术后7d、1个月及3个月2个组间UCVA比较差异均无统计学意义(均P＞0.05).二次撕囊组术眼的撕囊成功率为100％ (20/20),明显高于常规撕囊组的80％ (16/20),差异有统计学意义(x2=4.44,P＜0.05).术中二次撕囊组术眼未发现晶状体后囊膜破裂,常规撕囊组有4眼后囊膜破裂,组间比较差异有统计学意义(x2=4.44,P＜0.05).术后1d、3d常规撕囊组术眼轻度角膜水肿率分别为40％和45％,明显高于二次撕囊组的10％和15％,差异均有统计学意义(x2=4.80、4.19,均P＜0.05),2个组术后7d角膜均透明.2个组间术眼术后各时间点眼压的总体比较差异均无统计学意义(F分组=0.091,P=0.765;F时间=7.048,P＞0.05). 结论 过熟期白内障眼超声乳化白内障摘出术中采用二次撕囊技术与常规撕囊技术比较简单易行,无需特殊器械和材料,撕囊成功率高,术中及术后并发症少,有利于术后早期视力恢复.
