瞳孔扩张器在小瞳孔白内障超声乳化手术中的应用及比较  

Application of iris expander on phacoemulsification surgery for microcoria cataracts

作　　者：苏炳男 王进达 张景尚 熊瑛 李婧 李晓霞 万修华 

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研究所眼科学与视觉科学北京市重点实验室,100005

出　　处：《眼科》2017年第6期400-403,共4页Ophthalmology in China

基　　金：北京市科技新星计划(H020821380190);国务院妇女儿童工作委员会课题(2014108)

摘　　要：目的比较小瞳孔白内障超声乳化手术中应用OASIS和Malyugin Ring两种瞳孔扩张器的手术效果。设计前瞻性比较性病例系列。研究对象在北京同仁医院确诊并拟行小瞳孔白内障手术患者20例(20眼)。方法小瞳孔白内障患者20例(20眼)随机分为两组,其中术中采用Malyugin Ring瞳孔扩张器扩张瞳孔者11眼(1组),采用OASIS瞳孔扩张器扩张瞳孔者9眼(2组)。所有患者均施行3.2 mm透明角膜切口超声乳化吸除,术后1周,1、3、6个月随访复查,比较两组间手术前后最佳矫正视力、眼压、角膜内皮细胞计数、瞳孔大小等。主要指标最佳矫正视力、眼压、角膜内皮细胞计数、瞳孔大小。结果所有手术均由同一医师顺利完成,人工晶状体全部囊袋内植入,无术中并发症发生。手术前第1组和第2组的最佳矫正视力,分别为0.18±0.16和0.16±0.14(P=0.836);术后6个月第1组和第2组的最佳矫正视力分别为0.53±0.4和0.77±0.23(P=0.124)。术后6个月,第1组和第2组的眼压分别为(12.4±2.2)mm Hg和(12.7±6.4)mm Hg(P=0.364);角膜内皮细胞计数分别为(2089±729)个/mm2和(1246±516)个/mm2(P=0.007);瞳孔直径分别为(3.50±1.24)mm和(4.70±1.57)mm,均较术前瞳孔直径(分别为2.23±0.85 mm和1.94±0.50 mm)大(P=0.042,0.049)。结论小瞳孔白内障超声乳化手术时应用OASIS和Malyugin Ring两种瞳孔扩张器辅助均能在术中有效扩大并维持瞳孔扩张状态;术后瞳孔均较术前扩大;两组间术后视力恢复和眼压无明显差异,Malyugin Ring较OASIS瞳孔扩张器更有助于减少术中角膜内皮细胞丢失。Objective To compare the efficacy of the Malyugin Ring and OASIS iris expander applyied on the phacoemulsification surgery for the microcoria cataracts. Design Prospective comparative case series. Participants 20 microcoria cataract patients （20 eyes） from Beijing Tongren Hospital. Methods 20 microcoria cataract cases （20 eyes） were randomly divided into 2 groups. The pupils were dilated by Malyugin Ring in 11 eyes （group 1）, and by OASIS iris expander in 9 eyes （group 2）. 3.2 mm clear corneal incision were used in phacoemulsification. All cases were followed up at postoperative 1 week and 1, 3, 6 months. Main Outcome Measures The best corrected visual acuity （BCVA）, intraocular pressure（IOP）, corneal endothelial cell counts, and pupil size. Results All surgery was completed successfully by the same doctor. Intraocular lens were implanted in capsule, and no complications occurred. The preoperative BCVA of group 1 and 2 was 0.18±0.16 and 0.16±0.14 respectively （P=0.836）. The BCVA of group 1 and 2 was 0.53±0.40 and 0.77±0.23 respectively （P=0.124） at 6 months after surgery. At the 6 months after surgery, the IOP of group 1 and group 2 was 12.4±2.2 mmHg and 12.7±6.4 mmHg （P=0.364）, the corneal endothelial cell count was 2089±729/mm2 and 1246±516/mm2 （P=0.007）; the pupil diameter was 3.50±1.24 mm and 4.70±1.57 mm respectively, compared with the preoperative pupil diameter （2.23±0.85 mm and 1.94±0.50 mm respectively）（P=0.042, 0.049）. Conclusion Malyugin Ring and OASIS iris expander are safe and effective in microcoria cataract phacoemulsification. The pupils were larger postoperatively. Comparing with OASIS iris expander, Malyugin Ring helps to reduce the loss of intraoperative corneal endothelial cells.

关 键 词：白内障/外科学 小瞳孔 瞳孔扩张器 

分 类 号：R779.66[医药卫生—眼科]