截囊针预劈核技术和常规拦截劈核技术在合并假性剥脱综合征白内障手术中的比较  

A comparative study of cystotome-assisted prechop technique with stop-and-chop technique forpseudoexfoliation syndrome with cataract

作　　者：赵阳[1] 陈杰[2] 冯强[2] 肉孜买买提·买买提尼牙孜 高敏[2] 朱思泉[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,北京100730 [2]新疆维吾尔自治区和田地区人民医院五官科,和田848000

出　　处：《中华实验眼科杂志》2016年第3期265-269,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金青年项目（51302176）;国家自然科学基金项目（51573103、51273113）

摘　　要：背景假性剥脱综合征（PEX）在维吾尔族人群发病率较高，常引起继发性青光眼且多并发白内障。PEX眼晶状体组织的异常改变及悬韧带组织变性脆弱，超声乳化白内障摘出术中应用常规的拦截劈核过程易导致悬韧带断裂。截囊针预劈核技术是一种新的劈核技术，其在PEX合并白内障手术中的应用尚未见报道。目的比较截囊针预劈核技术与常规拦截劈核技术在PEX合并白内障患者超声乳化手术中的应用效果及安全性。方法采用完全随机对照的研究方法，于2015年3月至2016年1月在新疆维吾尔自治区和田地区人民医院五官科纳入晶状体核为Ⅲ级并且合并PEX的白内障患者41例41眼，采用随机数字表法将患者随机分成预劈核组和拦截劈核组，在白内障超声乳化白内障摘出联合IOL植入术中分别采用截囊针预劈核法及拦截劈裂法进行劈核，比较2个组术中所用的有效超声时间及术眼术后角膜内皮损失率、角膜水肿程度、视力及手术并发症的发生情况。结果预劈核组和拦截劈核组的平均有效超声时间分别为14．0（13．0，16．5）min和18．5（16．5，24．0）min，差异有统计学意义（Z=17．354，P〈0．01）。预劈核组和拦截劈核组术后1周术眼角膜内皮细胞计数分别为（2101．90±209．08）／mm和（2002．30±207．04）／mm，差异无统计学意义（t=-1．530，P=0．134）；预劈核组和拦截劈核组术后角膜内皮细胞丢失率分别为（8．27±2．23）％和（13．09±4．26）％，差异有统计学意义（t=3．810，P=0．001）。预劈核组术后3d的视力优于拦截劈核组，差异有统计学意义（P=0．044）；术后1d和3d，2个组间角膜水肿程度的差异均无统计学意义（P=0．221、0．446）。术中严重并发症主要为悬韧带断裂，预劈核组及拦截劈核组发生术中悬韧带断裂者分别为1眼和2眼。结论与常规拦截劈核技术比较，�Background Pseudoexfoliation syndrome （PEX） has a high incidence in Uygur population and usually leads to secondary glaucoma and complicated cataract. The abnormal change of lens tissue and degeneration of zonular fibers bring a lot of difficulties for phaeoemulsification （phaco） with intraocular lens implantation, especially stop-and-chop phaco technique. Prechop technique is a new choping technology, but its application in PEX with cataract is less. Objective This study was to compare the efficacy and safety of pre chop phaeo technique andstop-and-chop phaco technique for PEX combined cataract. Methods A randomized controlled Clinical trial was designed. Forty-one eyes of 41 patients with PEX combined cataract of II degree of nucleus were enrolled in People＇s Hospital of Hetian District from March 2015 to January 2016. The patients were randomized into the prechop group and stop-and-chop group according to random nubmer table,and cystotome-assisted prechop phaco surgery and stop- and-chop phaco surgery were performed in different groups, respectively. The effective phaco duration, corneal endothelium loss rate, cornea edema eye number after operation, vision outcomes and complications were compared between the two groups. Results The mean effective phaco duration was 14.0 （ 13.0,16.5 ） minutes and 18.5 （ 16. 5,24.0） minutes in the prechop group and stop-and-chop group ,with a significant difference between them （ Z= 17. 354 ,P〈0.01 ）. The corneal endothelial cells were （2 101.90 ±209.08 ）/mm in the prechop group, and the number was similar to （ 2 002.30 ± 207.04 ）/mm of the stop-and-chop group （ t = - 1. 530, P = 0. 134 ）. Corneal endothelial cell lossing rate was （8.27±2.23） % in the prechop group, which was lower than （ 13.09 ±4.26） % in the stop-and-chop group （t = 3.810, P = 0.001 ）. The BCVA was better in the prechop group than that in the stop-and- chop group in postoperative day 3 （P = 0. 044）, and the corneal edema degree was not signigicantly diff

关 键 词：白内障摘出术/方法 超声乳化白内障摘出术/方法 晶状体核/手术 假性剥脱 治疗效果 比较研究 预劈核技术 拦截劈核技术 

分 类 号：R779.66[医药卫生—眼科]