飞秒激光辅助白内障超声乳化术中不同碎核模式临床研究  

Clinical analysis of femtosecond laser fragmentation of the nucleus with different sizes in cataract surgery

作　　者：范巍[1] 张广斌[1] Fan Wei Zhang Guangbin.(Xiamen Ophthalmic Center, Xiamen University, Xiamen 361000, China)

机构地区：[1]厦门大学附属厦门眼科中心,福建省厦门市361000

出　　处：《中国实用眼科杂志》2017年第6期591-594,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的对比飞秒激光辅助白内障超声乳化手术中不同碎核模式下对术中累计超声乳化能量（CDE）、有效超声乳化时间（EPT）及术后角膜内皮丢失率的影响。方法前瞻性随机对照研究。对2015年6-11月在厦门大学附属厦门眼科中心行飞秒激光辅助白内障超声乳化联合人工晶状体置入术的患者66例（75只眼）晶状体混浊程度按LOCS III分级，运用随机数字表法分成3组：A组：网格＋交叉碎核模式（Frag：网格间距400 μm，Chop：八象限分割）；B组：圆柱状碎核模式（Cylin-der：直径3 mm）；C组：交叉碎核模式（Chop：六象限分割）；每组各25只眼。分别收集术前晶状体浑浊程度（LOCS III分级）、术中累积超声乳化能量（CDE）、有效超声乳化时间（EPT）及液流量，术后1月角膜内皮细胞丢失率及最佳矫正视力。结果三组患者术前LOCS III分级、角膜内皮细胞计数差异无统计学意义（P〉0.05）。A组患者术中CDE（4.7±2.8）较B组（6.4±3.1）、C组（6.6±3.0）下降，差异具有统计学意义（P〈0.05）；A组术中EPT（23.9±12.0）s较B组（30.8±11.7）s、C组（32.1±12.6）s下降，差异具有统计学意义（P〈0.05）；同时，A组术后角膜内皮细胞丢失率（4.2±4.3）%较B组（6.7±4.4）%、C组（7.2±4.8）%显著降低（P〈0.05）。三组患者术中液流量及术后1月角膜内皮细胞计数、最佳矫正视力差异均无统计学意义（P〉0.05）。结论在飞秒激光辅助白内障超声乳化手术中，采用网格联合交叉碎核模式可有效减少术中累积超声乳化能量（CDE）、有效超声乳化时间（EPT），软化晶状体核，减少术后角膜内皮细胞丢失率。Objective To compare the effect of different fragmentation softening grids in femto- second laser-assisted cataract surgery on cumulative dissipated energy （CDE）, effective phacoemulsification time （EPT）, balanced salt solution volume during surgery and corneal endothelial cell loss. Methods A prospective cohort study of all patients （66 cases, 75 eyes） who accepted femtosecond laser-assisted cataract surgery in Xiamen ophthalmic center during June 2015 to November 2015 were randomly divided into 3 groups： group A： Frag and Chop （350 mm fragmentation grids and octants）; group B： Cylinder （diameter：3.0mm）; group C： Chop （sestants）. Patients were evaluated preoperatively with the Lens Opacities Classification System III （LOCS III）. The CDE, EPT, balanced salt solution volume, corneal endothelial cell loss and best corrected visual acuity （BCVA） at one month were compared. Results There was no statistically significant difference inj LOCS III, preoperative corneal endothelial cell count in three groups （P 〉0.05）. Comparing with the group B and C, the CDE, EPT and postoperative corneal endothelial cell loss were significantly lower in group A （CDE：group A： 4.7±2.8, group B： 6.44-3.1, group C： 6.64-3.0; EPT： group A： 23.9±12.0s, group B： 30.8± 11.7s, group C： 32.1±12.6s; corneal endothelial cell loss： group A： 4.2±4.3%, group B： 6.7±4.4%, group C： 7.2±4.8%; P 〈0.05）. No statistically significant was found between balanced salt solution volume, postoperative corneal endothelial cell count and BCVA （ P 〉0.05）. Conclusions The use of the femtosecond laser-assisted system in cataract surgery with frag and chop led to a statistically significant lower CDE, EPT and postoperative corneal endothelial cell loss.

关 键 词：白内障超声乳化术 飞秒激光 角膜内皮细胞丢失率 碎核 临床研究 前瞻性随机对照研究 最佳矫正视力 P〉0.05 

分 类 号：R779.66[医药卫生—眼科]