撕囊碎核镊预劈核技术在硬核白内障超声乳化手术中的应用  

Application of capsulorhexis-chop forceps assisted prechop technique in hard cataract phacoemulsification

作　　者：许懋[1,2] 祁勇军 杨旸[1] 邓建华[1] 高竹阳[1] Mao Xu;Yong-Jun Qi;Yang Yang;Jian-Hua Deng;Zhu-Yang Gao(Department of Ophthalmology,Guangdong Provincial Hospital of Chinese Medicine,Zhuhai 519000,Guangdong Province,China;The First School of Clinical Medicine,Guangzhou University of Chinese Medicine,Zhuhai 519000,Guangdong Province,China)

机构地区：[1]广东省中医院珠海医院眼科,广东省珠海市519000 [2]广州中医药大学第一临床医学院,广东省珠海市519000

出　　处：《国际眼科杂志》2023年第6期1024-1028,共5页International Eye Science

基　　金：珠海市医学科研基金资助项目(No.ZH3310200006PJL)。

摘　　要：目的:分析撕囊碎核镊预劈核技术在Ⅳ级硬核白内障超声乳化手术中应用的优势。方法:前瞻性研究。纳入年龄相关性Ⅳ级硬核白内障患者100例100眼,利用随机数表法随机分为撕囊碎核镊预劈核组(A组)50例50眼,拦截劈核组(B组)50例50眼。对两组的术前术后角膜内皮细胞计数、术中超声乳化能量释放时间(US time)、术后角膜内皮细胞丢失率、术后1、7d角膜水肿分级计数情况以及术前术后最佳矫正视力(BCVA)进行比较和统计学分析。结果:A组平均US time为26.66(16,40)s,低于B组36.12(23,46)s(Z=-5.65,P<0.01)。术后3mo,A组平均角膜内皮细胞计数为2308.12±368.18cell/mm^(2),高于B组2104.06±379.87cell/mm^(2)(t=2.728,P=0.008)。术后3mo,A组平均角膜内皮细胞丢失率10%(8%,12%),低于B组17%(14%,20%)(Z=13.231,P<0.01)。术后1d角膜水肿为0、1、2、3、4级的眼数,在A组分别为0、23、21、6、0眼,在B组分别为0、9、26、15、0眼。A组角膜水肿轻于B组(Z=10.514,P=0.005)。术后1d A组患者BCVA优于B组患者,两组不同等级BCVA的眼数分布有差异(Z=7.176,P=0.029)。术后3mo两组不同等级BCVA的眼数分布无差异(Z=2.377,P=0.372)。结论:与拦截劈核技术相比,在Ⅳ级硬核白内障超声乳化手术中,撕囊碎核镊预劈核技术辅助白内障超声乳化手术使用超声能量少,角膜内皮细胞损伤小,适用于硬核白内障手术。AIM:To analyze the advantages of capsulorhexis-chop forceps assisted prechop(CCFP)technique in hard cataract phacoemulsification.METHODS:Prospective study.A total of 100 cases(100 eyes)with age-related grade IV hard cataract were included and randomly divided into 2 groups according to random number table,with 50 patients(50 eyes)in CCFP technique group(group A)and 50 cases(50 eyes)in stop-and-chop technique group(group B).The corneal endothelial cell count before and after operation,intraoperative US time,postoperative corneal endothelial cell loss rate,corneal edema grade at 1 and 7d and best corrected visual acuity(BCVA)were compared and statistically analyzed.RESULTS:The mean US time of group A was lower than that of group B[26.66(16,40)s vs.36.12(23,46)s;Z=-5.56,P<0.01].The mean corneal endothelial cell count in group A was higher than that in group B at 3mo after operation(2308.12±368.18cell/mm^(2) vs.2104.06±379.87cell/mm^(2);t=2.728,P=0.008),and the loss rate of corneal endothelial cells in group A was lower than that in group B at 3mo after operation[10%(8%,12%)vs.17%(14%,20%);Z=13.231,P<0.01].The number of eyes with corneal edema of grade 0,1,2,3 and 4 on 1d after surgery was 0,23,21,6 and 0 in group A,respectively,while it was 0,9,26,15 and 0 respectively in group B.Corneal edema in group A was less than that in group B(Z=10.514,P=0.005).The BCVA of group A was better than that of group B at 1d after operation,and there was significant difference in the number of eyes with different BCVA grades between the two groups(Z=7.176,P=0.029).There was no significant difference in the number of eyes with different grades of BCVA between the two groups at 3mo after surgery(Z=2.377,P=0.372).CONCLUSION:Compared with the stop-and-chop technique,CCFP technique uses less ultrasonic energy,has less damage to corneal endothelial cells and is suitable for hard cataract surgery.

关 键 词：白内障 预劈核技术 超声乳化手术 硬核 拦截劈核 

分 类 号：R779.66[医药卫生—眼科]