硬核白内障超声乳化手术中预劈核与拦截劈核技术的比较

doi:10.3760/cma.j.issn.1674-845X.2016.07.011

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摘要目的采用预劈核技术或拦截劈核技术的白内障超声乳化术治疗4～5级硬核白内障患者，比较两者手术疗效。方法前瞻性临床研究。将160例（160眼）硬核白内障患者根据手术方式不同分为观察组和对照组。观察组采用预劈核技术，用劈核钩与撕囊镊在囊袋内将核块劈为4~6块后，再行白内障超声乳化手术；对照组采用拦截劈核技术完成白内障超声乳化手术，2组病例术后均植入折叠型人工晶状体。观察2组患者平均超声乳化时间（US/TIME），累计释放能量（CDE），术后1、7 d视力及术后1 d角膜水肿情况。采用独立样本t检验和秩和检验对数据进行分析。结果观察组US/TIME、CDE明显小于对照组，差异有统计学意义（t=-35.69、-7.49，P＜0.01）；2组间术后1 d角膜水肿程度（Z=-3.117，P＜0.01）和视力提高比例（C2=18.95，P＜0.01）差异有统计学意义，但术后7 d视力提高比例差异无统计学意义（P＞0.05）。结论在硬核白内障手术中，采用预劈核技术，可有效减少刻槽及劈核所用的超声乳化能量，缩短超声乳化时间，患者角膜水肿程度轻，并发症少，视力恢复迅速，值得在临床工作中应用和推广。

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	陈冬斌
	董万江
	廖文勇
	颜瑞

关键词 ：超声乳化白内障吸除术, 预劈核技术, 拦截劈核技术, 硬核白内障

Abstract：Objective To compare the treatment effectiveness of using a pre-chop method and stop-and-chop method in phacoemulsification for cataracts with a grade IV-V hard nucleus. Methods This was a prospective clinical study. One hundred sixty patients (160 eyes) with hard nucleus cataracts were divided into a test group and control group. The pre-chop method was used in the test group. In this method, the cataract nucleus was chopped into 4 to 6 pieces using a chopper and capsulorhexis forceps, and then processed with phacoemulsification. The stop-and-chop method was used before phacoemulsification for the control group. A foldable intraocular lens was implanted in the eyes of both groups. The average ultrasonic emulsification time (UST), cumulative dissipated energy (CDE), corneal edema (1 days postoperatively) and patient vision (1 and 7 days postoperatively) were compared between the two groups. A t test and rank sum test were used to analyze the data. Results The test group′s average UST and CDE were lower than that of the control group, and the differences were statistically significant (t=-35.69, -7.49, P＜0.01). There were significant differences for both corneal edema on day one (Z=-3.117, P＜0.01) and vision capacity (C2=18.95, P＜0.01) between the two groups. But the differences in vision capacity at seven days were not significant (P＞0.05). Conclusion In cataract surgery for a hard nucleus, the pre-chop method can effectively reduce the amount of ultrasound energy needed for chopping and grooving and shorten UST. Corneal edema is alleviated with fewer complications and quick vision recovery. This is a worthwhile clinical application and should be promoted.

Key words： Phacoemulsification Pre-chop method Stop-and-chop method Hard nucleus cataract

通讯作者: 董万江，Email：gywjyk@126.com

引用本文:

陈冬斌,董万江,廖文勇,颜瑞. 硬核白内障超声乳化手术中预劈核与拦截劈核技术的比较[J]. 中华眼视光学与视觉科学杂志, 2016, 18(7): 433-435. Chen Dongbin, Dong Wanjiang*, Liao Wenyong, Yan Rui. Comparison of pre-chop and stop-and-chop techniques in phacoemulsification of hard-nucleus cataract. Chinese Journal of Optometry Ophthalmology and Visual science, 2016, 18(7): 433-435. DOI: 10.3760/cma.j.issn.1674-845X.2016.07.011

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https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2016.07.011 或 https://www.cjoovs.com/CN/Y2016/V18/I7/433

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