不同术式对高度近视眼白内障患者角膜水肿及影响因素的Logistic分析  

Different operative methods for high myopia cataract patients with corneal edema and Logistic analysis of influencing factors

作　　者：李谟汉 符小林[1] 羊文芳 

机构地区：[1]儋州市第一人民医院眼科,海南省儋州市571700 [2]儋州市第一人民医院检验科,海南省儋州市571700

出　　处：《眼科新进展》2016年第10期936-939,共4页Recent Advances in Ophthalmology

基　　金：海南省医药卫生科研基金资助(编号:15A200002)~~

摘　　要：目的 观察小切口白内障摘出并人工晶状体植入术与超声乳化白内障摘出并人工晶状体植入术后角膜水肿的发生率及影响因素。方法 收集2013年1月至2015年10月我院收治高度近视眼白内障手术患者292例（335眼）,随机分为对照组（140例159眼）和试验组（152例176眼）。对照组采用小切口白内障摘出并人工晶状体植入术,试验组采用超声乳化白内障摘出并人工晶状体植入术。观察对照组和试验组术后1 d、7 d角膜水肿情况及角膜容积,并应用多元Logistic回归分析术后角膜水肿发生的危险因素。结果 角膜水肿情况显示,术后1 d、7 d角膜水肿发生率对照组（32.7%、3.1%）与试验组（35.8%、5.1%）比较差异均无统计学意义（χ2=0.354、0.809,P=0.552、0.368）。核硬度分级显示,对照组核硬度≤Ⅲ级患者术后1 d和7 d角膜水肿发生率（27.9%、1.2%）与试验组（21.0%、1.0%）比较差异均无统计学意义（χ2=1.203、0.012,P=0.273、0.915）;对照组核硬度≥Ⅳ级患者术后1 d角膜水肿发生率（38.4%）明显低于试验组（55.3%）,差异有统计学意义（χ2=4.273,P=0.039）。角膜容积显示,两组患者术后1 d的CV3、CV5和CV7明显高于术前（均为P〈0.05）;对照组术后7 d的CV3、CV5和CV7明显低于试验组,差异均有统计学意义（t=2.645、2.896、3.265,P=0.023、0.019、0.014）。单因素分析显示,年龄、切口靠前、灌注压力高时间长、原角膜有损伤、后弹力层撕脱、晶状体核硬度是影响术后角膜水肿发生的因素（均为P〈0.05）。多元Logistic回归分析显示,切口靠前、灌注压力高时间长、后弹力层撕脱、核硬度Ⅲ~Ⅳ级、核硬度Ⅴ级与术后角膜水肿发生有关。结论 核硬度≥Ⅳ级患者小切口白内障摘出术较超声乳化白内障摘出术治疗效果好,切口靠前、灌注压力高时间长、后弹力层撕脱、核硬度Ⅲ~Ⅳ级、核硬度Ⅴ级可能是术后角膜水肿发�Objective To observe the incidence of corneal edema and its influen- cing factors after cataract extraction of either small incision or phacoemulsification with intraocular lens implantation. Methods Cataract surgery patients of 292 cases （ 335 eyes） were collected from January 2013 to October 2015 in our hospital. They were ran- domly divided into the control group （ 140 cases of 159 eyes） and the experimental group （152 cases of 176 eyes）. The control group received cataract extraction with small incision combined with intraocular lens implantation, and experimental group re- ceived phacoemulsification cataract extraction combined with intraocular lens implanta- tion. Corneal edema and corneal volume were observed at 1 day and 7 days after opera- tion in control group and experimental group, and the risk factors of corneal edema af- ter operation were analyzed by multivariate Logistic regression analysis. Results The corneal edema incidence in the control group were 32.7% ,3.1% at l day and 7 days, and the experimental group were 35.8% ,5. 1% , respectively, there was no statistically significant difference between two groups（x2 = 0. 354,0. 809 ;P =0. 552,0. 358 ）. Nuclear hardness classification showed that, the corneal edema incidence in patients with nucle- ar hardness less than or equal to grade Ⅲ at 1 day and 7 days in the control group were 27.9% , 1.2% , and the experimental group were 21.0% , 1.0% , respectively, there was no statistically significant difference between two groups（x2 = 1. 203,0. 012 ;P = 0. 273, 0.915 ）. The corneal edema incidence in patients with nuclear hardness more than or e- qual to grade lV in the control group （38.4%） was obviously lower than that in the ex- perimental group （55.3%）,the difference was statistically significant （X2=4. 273 ,P = 0. 039）. Corneal volume （CV） showed that, CV3 ,CV5 and CV7 at 1 day after operation in two groups were significantly higher than preoperative （ all P 〈 0.05 ）, and CV3, CV5 and CV7 in the control

关 键 词：高度近视 白内障 超声乳化摘出术 小切口白内障摘出术 角膜水肿 影响因素 

分 类 号：R776.1[医药卫生—眼科]