飞秒激光辅助超声乳化白内障吸除术的初步评估  

Preliminary evaluation of the femtosecond laser-assisted cataract surgery in 300 cases

作　　者：王勇 鲍先议[1] 周丽 许荣[1] 彭婷婷[1] 孙明[1] 曹丹敏 贺玲[1] 

机构地区：[1]武汉爱尔眼科医院中南大学爱尔眼科学院,430063

出　　处：《中华眼科杂志》2015年第9期689-693,共5页Chinese Journal of Ophthalmology

基　　金：爱尔眼科医院集团科研基金（AM142D17）

摘　　要：目的 总结飞秒激光辅助的超声乳化白内障吸除术（FLACS）的手术特征及术后效果.方法 回顾性分析2013年6月至2014年8月间在武汉爱尔眼科医院治疗的年龄相关性白内障患者的临床资料,其中观察组患者300例（300只眼）行FLACS,包括透明角膜切口制作,前囊膜切开、劈核及角膜松解切开矫正角膜散光.对照组300例（300只眼）行传统同轴微切口超声乳化白内障吸除术.LogMAR视力表记录两组术前最佳矫正视力（BCVA）,术后裸眼视力（UCVA）,超声乳化累积能量复合参数（CDE）,术中及术后并发症等数据.另外,还记录观察组飞秒激光参数包括固定眼球时间、负压吸引时间和飞秒激光时间.采用t检验比较两组间年龄、CDE、BCVA、UCVA.结果 99.33％的患者成功完成FLACS,其中固定眼球时间为（24.6±16.86）s,负压吸引时间为（101.2±20.0）s,飞秒激光时间为（23.3±5.5）s.术中CDE,观察组为5.52±5.18,对照组为8.37±7.91,差异有统计学意义（t=5.22,P＜0.05）.术后1d观察组与对照组UCVA分别为0.16±0.09及0.19±0.11,差异有统计学意义（t=6.09,P＜0.05）,术后1个月,观察组与对照组UCVA分别为0.12±0.08及0.13±0.11,差异无统计学意义（t=1.27,P＞0.05）.FLACS并发症主要有负压丢失（7/300,2.33％）,结膜下出血（58/300,19.33％）,瞳孔缩小（47/300,15.67％）,切口失败（13/300,4.33％）,前囊膜未完全游离（17/300,5.67％）,前囊膜口偏中心（11/300,3.67％）,核未劈开（5/300,1.67％）,后囊膜破裂（1/300,0.33％）.结论 FLACS的CDE低于传统超声乳化白内障吸除术,术后早期视力恢复更好,远期效果有待观察.Objective To evaluate the clinical outcome of the femtosecond laser-assisted cataract surgery （FLACS） in our first 300 cases.Methods In this retrospective study,the study group comprised 300 cases （300 eyes） in which FLACS was done.The control group comprised 300 cases （300 eyes） in which phacoemulsification was performed.The steps of the FLACS included capsulotomy,lens fragmentation,corneal incisions,and creation of incisions within the peripheral cornea to aid the correction of pre-existing astigmatism.After the FLACS,2.2-mm coaxial micro-incision phacoemulsification and implantation of an intraocular lens were operated.The preoperative best corrected visual acuity （BCVA） and postoperative uncorrected visual acuity （UCVA）,the cumulative dissipated energy （CDE） of the phacoemulsification,and the parameters of the FLACS,including the docking time,the suction time and the laser time,were recorded.The complications of the FLACS were analyzed.Results The FLACS was successfully completed in 99.33% of the cases.The docking time was （24.6± 16.8）sec,the suction time was （101.27±20.09）sec,and the laser time was （23.3±5.5）sec.The most common complications of the FLACS included suction break （7/ 300,2.33%）,subconjunctival hemorrhage （58/300,19.33%）,pupillary constriction （47/300,15.67%）,incision at a wrong site （13/300,4.33%）,anterior capsular tag （17/300,5.67%）,decentration of the capsulorhexis （11/300,3.67%）,failure to split the lens nucleus （5/300,1.67%）,and posterior capsular ruptures （1/300,0.33%）.The CDE was 5.52±5.18 in the FLACS group and 8.37±7.91 in the traditional phaco group（P〈0.05）.The UCVA was 0.12±0.08 and 0.13±0.11 at 1 month after the FLACS and traditional phaco,respectively （P〉0.05）.Conclusions Compared with the conventional phacoemulsification surgery,the FLACS can achieve less CDE and better early postoperative visual acuity.Long-term effects remain to be investigated.

关 键 词：激光 飞秒 超声乳化白内障吸除术 白内障 治疗结果 

分 类 号：R779.66[医药卫生—眼科]