老年人白内障膨胀期囊外摘除术和超声乳化术疗效的对比研究  

Effect of phacoemulsification versus extracapsular cataract extraction in patients with intumescent senilecataract

作　　者：王铮[1] 卢颖毅[1] 卢光[1] 陈彤[1] 

机构地区：[1]卫生部北京医院眼科,100730

出　　处：《中华老年医学杂志》2014年第3期290-293,共4页Chinese Journal of Geriatrics

摘　　要：目的对比研究膨胀期老年人白内障采用超声乳化和小切口囊外摘除手术方式的安全性和手术效果。方法前瞻性随机对照研究，将符合入组标准的200例（200只眼）膨胀期白内障患者随机分成两组，108例（108只眼）使用白内障超声乳化技术（phacoemulsification，PE），92例（92只眼）采用小切口囊外摘除术（extracapsular cataract extraction，ECCE）。患眼均选择上方巩膜隧道切VI，胎盘蓝囊膜染色后，PE组行最小化连续环形撕囊（continuous curvilinear capsulorhexis，CCC），设计撕囊直径约41mm。常规超声乳化、置人人工晶状体后再扩大撕囊直径至6mmECCE组行常规连续环形撕囊或开罐式截囊，设计直径7～8mm。水化晶状体核后，扩大巩膜隧道切口至6～7mm，圈套器娩出晶状体核。对两组患者的术中、术后并发症及术后效果进行统计分析。结果两组患者年龄，性别和核硬度比较差异无统计学意义（均P〉O．05）。术前2组患者最佳矫正视力均≤0．05（100％），术后3dPE组105只眼最佳矫正视力≥O．05（97．2％，105/108），82只眼≥0．3（75．9％，82/108）。ECCE组89只眼最佳矫正视力≥O．05（96．7％，89/92），72只眼≥O．3（78．3％，72/92）。两组的脱盲率、脱残率比较差异无统计学意义（X^2值分别为0．04、0．15，P=0．84，P=0．70）。PE组连续环形撕囊的失败率（8．3％，9/108），囊膜向周边放射状裂开率（20．4％，22/108）和后囊膜破裂、玻璃体丢失（O．9％，1/108）、虹膜脱出（O％，0／108）等术中并发症发生率低于小切口ECCE组（分别为20．7％，19/92；39．1oA，36/92；7．6％，7/92；15．2％，14/92），差异均有统计学意义（P=0．O1，P=0．00，P=0．02，P〈O．001）。仅ECCE组出现术后虹膜脱出、瞳孔变形等并发症。结论采用小切口、小的环形撕囊、超声乳化术式，对于膨胀期自内障可以获得�Objective To compare the safety and effect of the phacoemulsification （PHACO） versus extracapsular cataract extraction （ECCE） in patients with intumescent senile cataract. Methods 200 eyes from patients with intumescent cataract were included and randomly divided into 2 groups： PE group （108 eyes, received PHACO） and ECCE group （92 eyes, received small incision ECCE） respectively. Superior quadrant sclera tunnel incisions were made with stabs of 2.8 mm diameters. Trypan-blue was used to show the anterior lens capsular membrane. In the PHACO group, a 4 mm diameters continuous curvilinear capsulorhexis （CCC） was made, which was enlarged to 6-7 mm after the intraoeular lenses （IOL） implantation. For the ECCE group, a 8 ram-diameter CCC was made. Then the lens nucleus was either phacoemulsificated or delivered and IOL was implanted. The complications during and after surgery and the visual outcomes were recorded and statistically analyzed by SPSS 13.0 software. Results Age, sex and the hardness of the nucleus were comparable between the two groups. The best corrected vision acuity （BCVA） was 0.05 and worse in all patients before surgery. While 3 days after operation, in PE group, 105 eyes （97.2%, 105/108） gained postoperative vision 0. 05 and better, and 82 of them were better than 0.3; in group ECCE, 97.2% （89/92） of the operated eyes gained vision 0.05 and better, 72 （78.3%, 72/92） eyeswere better than 0.3. No statistical differences were found between the two groups in postoperative vision recovery. While, there were more failure rates of the CCC, tear of the anterior and posterior capsular, loss of the vitreous and iris injury rate in the ECCE group than in the PE group （20. 7% vs 8.3%, 17.4%vs 12.0M, 7.6% vs 0.9%, 15.2M vs 0%, P=0.01,P=0.00,P=0.02,P〈 0. 001）. Prolapse of iris and discoria were found in ECCE group. Conclusions With small CCC, phacoemulsification can lead to better surgical outcomes than small incision ECCE procedures, and the operative and post-oper

关 键 词：超声乳化白内障吸除 晶体 

分 类 号：R779.66[医药卫生—眼科]