飞秒激光辅助白内障摘除手术的临床分析  

Clinic analysis of femtosecond laser-assisted cataract surgery

作　　者：张广斌[1] 叶向彧[1] 陈伟[1] 毛祖红[1] 王乐[1] 李孟琼[1] 

机构地区：[1]厦门大学附属厦门眼科中心,361000

出　　处：《中华眼科杂志》2016年第2期93-98,共6页Chinese Journal of Ophthalmology

基　　金：基金项目：福建省自然科学基金（2012D041）;厦门市科技计划指导项目（ZD2011S0333）;厦门市科技惠民项目（3502220144043）

摘　　要：目的 评估飞秒激光辅助超声乳化白内障吸除手术的安全性及有效性.方法 病例对照研究.2013年4月至11月在厦门眼科中心行超声乳化白内障手术的患者233例（314只眼）,将其分为飞秒激光组（153只眼）及传统超声乳化组（161只眼）,比较两组术前一般情况,术中超声乳化能量释放量（CDE）、有效超声时间（EPT）、角膜内皮丢失量、房水闪光值及术后并发症.计量资料采用独立样本t检验;计数资料采用交互列表的卡方或者Fisher确切概率法分析.结果 两组术前一般情况（年龄、性别、眼压、眼轴、角膜曲率、前房深度、核分级）差异无统计学意义（P＞0.05）.飞秒激光组CDE、EPT分别为4.78％（3.18％～8.88％）和14.05 s（10.07 ～ 20.85 s）,小于传统超声乳化组的8.82％（6.01％～19.16％）和23.65 s（18.36 ～ 46.96 s）,差异有统计学意义（z=2.30,2.91;P＜0.05）.飞秒激光组撕囊相对直径和圆形度均较传统超声乳化组更精确（t=2.58,3.92;P＜0.05）.角膜内皮丢失量在术后1个月时飞秒激光组为73.50（-69.51～ 111.03）个/mm^2,低于传统超声乳化组的118.06（53.55～299.03）个/mm^2,差异有统计学意义（z=2.44;P＜0.05）.房水闪光值在术后1d激光组18.81（13.32～20.23） ph/ms,传统超声乳化组24.51（16.38～ 32.18） ph/m和1个月时飞秒激光组13.01（9.23～ 16.28） ph/ms,传统超声乳化组18.05（12.37～ 24.97） ph/ms,传统超声乳化组均高于飞秒激光组,差异有统计学意义（z=2.40,2.31;P＜0.05）.两组术后均无严重并发症出现.结论 飞秒激光辅助超声乳化白内障吸除手术具有较高安全性及有效性,可降低CDE和减少EPT,进而减少角膜内皮损伤和术后前房反应,且撕囊更精确、重复性更好.Objective To evaluate the safety and effectiveness of femtosecond laser-assisted cataract surgery.Methods The interventional case series enrolled 314 eyes undergoing cataract surgery in Xiamen Ophthalmic Center between April and December 2013,patients were randomized to femtosecond laser-assisted cataract surgery（153 eyes） and conventional phacoemulsification cataract surgery（161 eyes）.The clincic parameters of preoperation,during operation and postoperation were compared and statistically studied.Quantitative data were analyzed using the analysis of variance,independent t tests.Qualitative datawere analyzed using the crosstabs analysis chi-square test or the Fisher＆#39;s exact test.Results The patient＆#39;s demographics parameters（age,gender,IOP,axial length,mean keratometry,AC depth,Cataract grade） did not differ significantly between groups （P〉0.05）.The CDE showing 4.78% （3.18%-8.88%）and EPT showing 14.05 s （10.07-20.85 s）in the laser group were significantly lower than the CDE showing 8.82% （6.01%-19.16%） and EPT showing 23.65 s （18.36-46.96 s） in the conventional group （z=2.30,2.91;P〈0.05）.The relative diameter and circularity in laser-assisted capusulotomies were significantly more accurate （t=2.58,3.92;P〈0.05）.The corneal endothelial cell loss showing 73.50 （-69.51-111.03）/mm^2 was significantly lower in the laser group than the loss of 118.06 （53.55-299.03）/mm^2 in the conventional group 1 month postoperatively （z=2.44;P〈0.05）.Postoperative anterial chamber flare was significantly greater in the conventional group at 1 day of 18.81 （13.32-20.23） ph/ms in laser group,24.51（16.38-32.18）ph/m in conventional group and at 1 month of 13.01（9.23-16.28） ph/ms in laser group,18.05（12.37-24.97） ph/ms in conventional group than the laser group （z=2.40,2.31;P〈0.05）.There were no severe surgical complications for both groups.Conclusions The femtosecond laser-assisted cataract surgery was effective and safe.It reduced EPT and CDE duri

关 键 词：激光 飞秒 超声乳化白内障吸除术 晶体囊撕裂术 内皮 角膜 

分 类 号：R779.66[医药卫生—眼科]