小瞳孔白内障超声乳化手术中应用OASIS瞳孔扩张器的疗效观察  

Effects of OASIS iris expander in phacoemulsification surgery of cataract with small pupil

作　　者：王进达 张景尚 熊瑛 李婧 李晓霞 赵晶 朱谷雨 万修华 WANG Jin-Da;ZHANG Jing-Shang;XIONG Ying;LI Jing;LI Xiao-Xia;ZHAO Jing;ZHU Gu-Yu;WAN Xiu-Hua(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital of Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100005,China;Beijing Tongren Eye Center,Beijing Tongren Hospital of Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100005,China)

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、北京市眼科学与视觉科学重点实验室,北京市100005 [2]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,北京市100005

出　　处：《眼科新进展》2018年第2期161-163,167,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金面上项目(编号:30471861、81470635);北京市科技新星项目(编号:H020821380190、Z13110200-0413025);国务院妇女儿童工作委员会课题(编号:2014108);北京市眼科研究所引领计划(编号:201515)

摘　　要：目的评价小瞳孔白内障超声乳化手术中应用OASIS瞳孔扩张器的效果。方法本文为前瞻性病例对照研究,收集临床工作中的小瞳孔白内障患者22例22眼,随机分为2组,其中术中采用器械瞳孔撕开操作13眼(A组),采用OASIS瞳孔扩张器扩张瞳孔9眼(B组)。所有病例均施行3.2 mm透明角膜切口超声乳化吸除,术后1周、1个月、3个月、6个月随访复查,比较手术前后最佳矫正视力(best corrected visual acuity,BCVA)、眼压、角膜内皮细胞计数、瞳孔大小变化。采用独立样本t检验的方法进行统计分析。结果所有手术均由同一医师顺利完成,人工晶状体100%囊袋内植入,未见手术并发症发生。术后6个月BCVA(A组0.41±0.30、B组0.77±0.23)与术前(A组0.17±0.14、B组0.16±0.14)比较,2组均显著提高;但2组间差异无统计学意义(均为P>0.05)。术后6个月眼压:A组(14.62±4.70)mm Hg(1 k Pa=7.5 mm Hg)、B组(12.67±6.35)mm Hg,与术前A组(14.22±6.00)mm Hg、B组(15.70±5.70)mm Hg相比无明显变化;2组间差异均无统计学意义(均为P>0.05)。术后6个月角膜内皮细胞计数:A组(1486±718)个·mm^(-2)、B组(1246±516)个·mm^(-2),与术前A组(2498±564)个·mm^(-2)、B组(2424±640)个·mm^(-2)均明显减少;B组角膜内皮细胞计数损失更多,差异无统计学意义(P=0.091)。2组瞳孔直径均较术前扩大:术前A组(2.30±0.35)mm、B组(1.94±0.50)mm,术后A组(4.00±0.88)mm、B组(4.70±1.57)mm,2组间差异均无统计学意义(均为P>0.05)。结论小瞳孔白内障超声乳化手术时使用OASIS瞳孔扩张器辅助可在术中有效扩大并维持瞳孔扩张状态,不影响术后视力恢复和眼压情况;术后瞳孔较术前扩大。Objective To assess the outcomes of OASIS iris expander in phacoemulsification surgery of cataract with small pupil.Methods A prospective case-control study was conducted in 22 microcoria cataract patients(22 eyes).And they were randomly divided into group A and B,in which the pupils of group A were dilated by tearing instruments in 13 eyes,and the pupils of group B were dilated using OASIS iris expander in 9 eyes.All patient underwent phacoemulsification with 3.2 mm clear corneal incision and were followed up at postoperative 1 week,1 month,3 months and 6 months.Finally,the best corrected visual acuity(BCVA),intraocular pressure(IOP),corneal endothelial cell counts,pupil size before and after surgery were recorded and analyzed by an independent sample t test.Results All procedures were completed successfully by the same skilled doctor.Intraocular lenses were implanted in capsule completely,and no complications occurred.At 6 months after operation,patients’BCVA in group A(0.41±0.30)and group B(0.77±0.23)was significantly higher than that in group A(0.17±0.14)and group B(0.16±0.14)before operation,but there was no statistical difference between the two groups(all P>0.05);whereas there was no significant change in the IOP of group A and B at 6 months after operation(1 kPa=7.5 mmHg)and before operation[(14.22±6.00)mmHg vs.(15.70±5.70)mmHg)](all P>0.05).Moreover,corneal endothelial cell counts in group A[(1486±718)cells·mm-2]and B[(1246±516)cells·mm-2]were significantly smaller than those before operation[(2498±564)cells·mm-2 vs.[(2424±640)cells·mm-2],with no significant difference(P=0.091).The postoperative diameter of the pupil in group A[(4.00±0.88)mm]and group B[(4.70±1.57)mm]after operation was larger than that in group A[(2.30±0.35)mm]and group B[(1.94±0.50)mm]before operation,and there was no statistical difference between the two groups(all P>0.05).Conclusions OASIS iris expander can help to dilate and hold pupils and does not affect the postoperative visual acuity and intraocular pressure

关 键 词：白内障 小瞳孔 瞳孔扩张器 

分 类 号：R779.6[医药卫生—眼科]