硬核性白内障行小切口白内障摘除术和超声乳化白内障吸除术的效果观察  

Clinical observation on hard cataract extraction with small incision cataract surgery or phacoemulsification by soft-shell technique

作　　者：孙理彬 

机构地区：[1]河南省许昌市人民医院眼科,461000

出　　处：《中华眼科医学杂志（电子版）》2014年第1期15-18,共4页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：目的 比较超声乳化白内障吸除术与小切口白内障摘除术治疗硬核性白内障的临床疗效。方法 回顾性分析在河南省许昌市人民医院眼科就诊的139例(139只眼)Ⅳ~Ⅴ级硬核白内障患者的临床资料。采用数字表法随机分为A、B两组。其中实施超声乳化白内障吸除术的患者为A组,共计63例(63只眼);实施小切口白内障摘除术的患者为B组,共计76例(76只眼)。观察术后两组患者的视力及手术并发症情况。两组患者术后视力和术后角膜水肿情况比较采用卡方检验,两组患者的手术成功情况比较采用手术成功率描述。结果 A组术后第1天视力】0.1的患者占71.4%(45/63),术后第7天视力】0.1的患者占92.1%(58/63);B组术后第1天视力】0.1的患者占85.5%(65/76),术后第7天视力】0.1的患者占94.7%(72/76)。术后第1天患者视力B组优于A组,两组比较差异有统计学意义(χ2=4.15,P=0.042)。术后第7天两组视力比较,差异无统计学意义(χ2=0.41,P=0.524)。术后第1天A组发生角膜水肿的患者占22.2%(14/63),B组发生角膜水肿的患者占9.2%(7/76);术后第7天,A组发生角膜水肿的患者占1.59%(1/63),B组发生角膜水中的患者占2.63%(2/76)。术后第1天角膜水肿发生率A组高于B组,两组比较差异有统计学意义(χ2=4.96,P=0.033)。术后第7天两组角膜水肿发生率比较,差异无统计学意义(χ2=0.23,P=0.673)。A组完成超声乳化白内障吸除术的患者占79.4%(50/63),黑核基本超不动,仅可清除核前部半透明皮质,扩大切口后改为小切口白内障摘除术。B组100%完成小切口白内障摘除术。A组患者术中发生切口灼伤者7例(11.1%),后囊膜破裂者2例(3.2%),超声乳化针头折断者1例(1.6%)。B组患者术中发生后囊膜破裂者1例(1.3%),前房出血者3例(3.9%)。两组患者均无角膜内皮细胞失代偿、爆发性脉络膜上腔出血、视网膜脱离及眼内炎等严重并发症。结论 硬核性白内障更适合采用�Objective To compare the therapeutic effect of phacoemulsification and small incision cataract surgery on hardness cataract by soft shell technique.Methods It was a retrospective study.A total of 139 cases ( 139 eyes ) with Ⅳ-Ⅴ degree cataract from Jan.2012 to Sep.2013 in Department of Ophthalmology,People′s Hospital of Xuchang were randomly divided into group A with 63 cases (63 eyes) and B with 76 cases (76 eyes) .Group A was treated with phacoemulsification and group B was treated with cataract surgery through a small-incision.Postoperative visual acuity and complications were compared by chi-square test.The achievement ratio of operation between two groups was compared by rate.All cases were followed-up for 1 week.Resuluts One day after the operation,the rate of visual acuity greater than 0.1 in small-incision cataract surgery group was 85.5% ( 65/76 ), significantly higher than that in phacoemulsification group(χ2=4.15,P =0.042),which was 71.4%(45/63).One week after operation,the rates of patients whose visual acuity was more than 0.1 was 92.1%(58/63)in small-incision cataract surgery group and 94.7%( 72/76 ) in phacoemulsification group respectively.The difference was not statistically significant(χ2=0.23;P=0.673).On the first postoperative day,22.2%(14/63) patients had corneal edema in group A,significantly more than that in group B,which was 9.2%(7/76)(χ2=4.96,P =0.033). 1 week after operation,corneal edema occured in 1.59%(1/63) patients in group A and 2.63%(2/76) in group B .Difference was not statistically significant(χ2=0.23,P =0.673) .The achievement ratio of operation was 79.4%(50/60) in group A and 100%(76/76) in group B.In group A,11.1%(7/63) had incision burned, 3.2%(2/63) had posterior capsule rupture, 1.6%(1/63) had handle tip snapped. In group B, 1.3%(1/76) had posterior capsule rupture and 3.9%(3/76) had hyphema.Serious complications were not observed in both groups.Conclusion Non-phacoaemmulsification small incision cataract surgery is more suitable for super hard cataract than pha

关 键 词：硬核性白内障 超声乳化白内障吸除术 小切口白内障吸除术 软壳技术 角膜水肿 并发症 

分 类 号：R779.66[医药卫生—眼科]