【摘要】 目的:比较白内障超声乳化大小两种透明角膜切口术后视力及散光度数的差异。方法:选择老年性白内障160例160眼分别行白内障超声乳化5.5mm透明角膜切口(A组)与3.2mm透明角膜切口 (B组)植入术后1wk;1,3,6mo进行视力及散光度数比较。结果:术后1wk裸眼视力A组明显低于B组,术后1,3,6mo裸眼视力A组与B组比较无明显差异;术后1wk;1mo角膜散光度数比较A组明显高于B组,术后3,6mo角膜散光度数A组与B组比较无明显差异。 结论:基层医院面向经济欠发达的农村地区开展5.5mm透明角膜切口硬质人工晶状体植入术是行之有效的。
【关键词】 白内障超声乳化;透明角膜切口;基层医院;农村地区
Comparison of two kinds of transparent corneal incision of cataract phacoemulsification
ShuFeng Zheng, YingXian Zhao, WuJun Li
Department of Ophthalmology, Northern Hospital of Traditional Chinese Medicine of Yulin, Yulin 719000, Shaanxi Province, China;Department of Ophthalmology, Hengshan County Hospital, Hengshan Conty 719100, Shaanxi Province, China
Abstract AIM: To compare the difference in the vision and astigmatism degree after the cataract phacoemulsification with two types of transparent corneal incision. METHODS: Selected 160 senile cataract patients were divided into group A and group B. Group A received the cataract phacoemulsification with 5.5mm transparent corneal incision, while group B was 3.2mm. Then the difference in the vision and astigmatism degree were compared in the 1st week, the 1st, the 3rd and the 6th month after operation. RESULTS: The unaided vision of group A was obviously worse than that of group B the first week after operation. There was no obvious difference the first, third and sixth month after operation. The astigmatism degree of group A was obviously higher than that of group B the first week and the first month after operation. There was no obvious difference in corneal astigmatism degree the third and sixth month after operation. CONCLUSION: The implantation of rigid intraocular lens with 5.5mm transparent corneal incision is available for the elementary hospital when they serve the rural area. KEYWORDS: phacoemulsification; corneal incision; elementary hospital; rural area
0引言 随着社会进入老龄化,白内障成为全世界首要致盲性眼病,它的治疗备受重视,并且方法日益先进,在当前白内障手术已经进入了一个崭新的阶段,白内障超声乳化联合人工晶状体植入术目前已成为白内障治疗首选的手术方式[1],此术式以其具有切口小、不用缝合、手术时间短、手术后视力恢复快受到医生和患者的青睐。手术切口大小为影响术后角膜散光及视力恢复的重要因素。为了解不同大小透明角膜手术切口植入不同直径人工晶状体对术后视力、散光度数的影响,我们将白内障超声乳化5.5mm透明角膜切口硬质人工晶状体植入与3.2mm透明角膜切口折叠式人工晶状体植入术后视力及散光度数进行比较,以探讨、寻找基层医院为在经济欠发达的农村地区白内障患者治疗的手术方式。
1对象和方法
1.1对象 随机选取200512/200812在我院施行白内障超声乳化术资料完整的老年性白内障患者160例160眼,其中男86例86眼,女74例74眼,年龄56~82(平均68)岁,术前视力均<0.5,晶状体核混浊均选择IV级核以下,排除伴有其他眼病并能配合随访的患者,按不同透明角膜切口分为两组:A组80眼行5.5mm透明角膜切口植入硬质人工晶状体;B组80眼行3.2mm透明角膜切口植入折叠式人工晶状体。选取病例术中人工晶状体均植入于囊袋内,术后角膜水肿均在1wk内消退,并均无后囊破裂等其他术后并发症,随访6mo。
1.2方法 人工晶状体度数计算均应用YZ38角膜曲率计1类B型测量角膜曲率,BME100眼科A型超声波测量眼轴长度,按SRKII回归公式D=A2.5L0.9K计算后房型人工晶状体度数[2],D为术中植入的人工晶状体度数(以BME100眼科A型超声波测量值换算为准),屈光度0.50~0.50D。手术方法:全部病例均选用表面麻醉、由同一位资深医师在同一手术显微镜下、应用同一超声乳化仪完成,均应用同一厂家生产的隧道刀和角膜穿刺刀,均应用同一黏弹剂,切口均选在鼻上(左眼)或颞上(右眼),表面麻醉成功后做透明角膜切口,隧道长1.75~2mm,连续环形撕囊直径约5.5~6mm,水分离及水分层,超声乳化吸除晶状体核,注吸皮质,抛光处理晶状体后囊膜,5.5mm切口植入日本产ROHTo硬质人工晶状体,3.2mm切口植入AlconSN60AT,HOYA60BB折叠式人工晶状体,均植入于晶状体囊代内,I/A系统吸除黏弹剂,平衡盐溶液恢复前房深度,确认前房稳定,切口达水密状态,角膜切口均不缝合,均自闭。所有患者均于手术后1wk;1,3,6mo进行裸眼视力和散光度数检查、统计,其中散光度数1wk时均用同一电脑验光仪所得,1mo后均由同一娴熟的专业技师在散瞳下用带状光检影所得。
表1 裸眼视力比较(略)
表2 两组术后散光度数比较(绝对值)(略)
表3 两组术后散光度数(略)
统计学分析:采用χ2检验分别对A,B两组术后1wk;1,3,6mo的裸眼视力、角膜散光度数进行统计。
2结果
2.1术后患者视力比较 术后患者视力比较(表1),我们从中可以看到术后1wk A组裸眼视力明显低于B组,有显著性差异,具有统计学意义,术后1,3,6mo A,B两组的裸眼视无明显差异,无统计学意义。从中还可以看到两组术后视力随时间延长均呈渐进提高并趋于稳定。
2.2术后患者散光度比较 术后患者散光度数比较见表2,3术后1mo,A组的散光值明显高于B组(P<0.01),差异具有高度统计学意义,术后1mo较B组散光值高,差异具有统计学意义,手术后3,6mo两组患者的角膜散光无明显差异(P>0.05),差异无统计学意义。从表1,2还可以看出,两组术后散光度数随时间的延长均减小并趋于稳定。
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