爆破模式的超声乳化白内障吸除术  

Phacoemulsification using burst mode

作　　者：刘奕志[1] 程冰[1] 

机构地区：[1]中山大学中山眼科中心,广州510060

出　　处：《中华眼科杂志》2004年第4期239-242,共4页Chinese Journal of Ophthalmology

摘　　要：目的　探讨以爆破结合高真空模式行超声乳化白内障吸除术的效果。方法　将晶状体核硬度 >Ⅲ级的白内障患者 819例 (95 4只眼 )随机分为连续组、脉冲组及爆破组行颞侧透明角膜隧道切口超声乳化白内障吸除术。术中设定负压连续组和脉冲组为 16 0mmHg(1mmHg =0 133kPa) ,爆破组为 2 5 0～ 30 0mmHg;最大能量均为 6 0 %。记录 3组患者术中实际使用的超声能量和时间、视力及角膜内皮细胞密度 ,并观察手术并发症的发生情况。结果　连续组、脉冲组及爆破组术中实际使用的超声能量分别为 2 5 36 %± 6 6 5 %、19 5 4 %± 3 5 0 %及 6 2 7%± 1 2 7% ;超声时间分别为 (2 2 2± 30 )s、(186± 4 1)s及 (36± 6 )s;比较 3组所用超声能量和时间 ,差异均有非常显著意义 (P =0 0 0 5 ,0 0 0 0 1)。3组患者术后视力均有提高 ,连续组与脉冲组比较 ,差异无显著意义 (P =0 0 6 2 ) ;与爆破组比较 ,差异有显著意义 (P =0 0 0 2 )。术后爆破组角膜内皮细胞丢失率明显低于连续组和脉冲组 (P =0 0 0 5 ,0 0 0 1)。连续组术后角膜水肿 (+++)者多于脉冲组和爆破组。结论　应用爆破结合高真空模式行超声乳化白内障吸除术 ,可明显减少超声能量和时间 ,降低角膜内皮细胞丢失率 ,减轻术后早期角膜水肿 ,值得推广使用。Objective To observe the effect of burst mode combined with high vacuum on phacoemulsification.Methods Nine hundreds and fifty-four eyes (819 patients) were randomly divided into three groups (continue group,pulse group and burst group). Each group consisted of 318 eyes. A temporal clear corneal incision was performed in each group. Various phaco modes were used. In continue group, the vacuum was 160 mm Hg,max phaco power was 60%. In pulse group,vacuum was 160 mm Hg and the power was 60%. In burst group,vacuum was 250-300 mm Hg and the power was 60%. Actual phaco power,phaco time,visual acuity,corneal endothelial cell loss and other complications were recorded.Results The actual phaco power in these 3 groups was 25.36%±6.65%,19.54%±3.50% and 6.27%±1.27%,respectively. Phaco time in these 3 groups was (222±30),(186±41) and (36±6) seconds,respectively. In comparison of the power and time among these 3 groups,the difference between continue group and pulse or burst group was significant ( P =0.005 and 0.0001). Visual acuity was significant improved in all 3 groups postoperatively. The difference between the continue group and the pulse group was not significant. The difference between the continue group and burst group was statistically significant. There was no statistically significant difference in mean number of corneal endothelial cell between these 3 groups preoperatively. Endothelial cell loss postoperatively was lower in the pulse and burst groups than that in the continue group. The difference was significant between the continue group and pulse or burst group ( P =0.005 and 0.001). Serious corneal edema occurred more frequently in the continues group than that in the pulse and burst groups. Conclusion High vacuum combined with pulse or burst phaco mode reduced phaco time and actual phaco power consumed during phacoemulsification,especially in the burst mode,which enhanced the effectiveness of phaco chop and reduced the loss of corneal endothelial cell and corneal edema. It is safe to use the burst pha

关 键 词：爆破模式 超声乳化吸除术 白内障 真空模式 术后视力 

分 类 号：R779.66[医药卫生—眼科]