不同大小透明角膜切口超声乳化术治疗放射状角膜切开术后白内障

doi:10.3760/cma.j.issn.1674-845X.2017.10.004

摘要
图/表
参考文献(15)
相关文章 (15)

全文: PDF 17351KB HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要

目的：评估不同大小透明角膜切口超声乳化术治疗放射状角膜切开术（RK）后白内障的临床效果。方法：回顾性系列病例研究。收集2011 年1 月至2015 年8 月在首都医科大学附属北京同仁医院行白内障超声乳化手术且既往有RK史的患者16例（26眼），其中RK角膜瘢痕为8刀者3例（6眼），12刀者8 例（12 眼），16 刀者5 例（8 眼）。由同一手术医师进行透明角膜切口白内障超声乳化术联合人工晶状体植入术，8 刀者中4 眼采用3.2 mm透明角膜切口，2 眼采用3.0 mm透明角膜切口；12 刀者中4 眼采用3.2 mm透明角膜切口，8 眼采用2.2 mm透明角膜切口；16 刀者中5 眼采用3.2 mm透明角膜切口，3眼采用2.0 mm透明角膜切口。分别于术后1 d，1 周，1、3、6、12、24、36 个月进行随访，观察并记录角膜RK瘢痕情况，术后视力恢复情况及术后有无并发症发生。对术前与术后1 个月、最后1 次随访时的各项参数采用配对t 检验进行比较。结果：RK角膜瘢痕为8 刀者和12 刀者术中均未发生RK瘢痕裂开，术毕切口密闭良好；16 刀者中采用3.2 mm透明角膜切口者2 眼术中发生角膜瘢痕裂开，前房注入无菌空气封闭切口，切口密闭良好，余6 眼均未发生术中角膜瘢痕裂开。术后随访时间为1~36（12.9±11.6）个月。26眼术后角膜切口密闭良好，均未出现新发角膜瘢痕裂开。最后1 次复查时最佳矫正视力（BCVA，LogMAR）为0.19±0.12，较术前提高（t =-6.913，P <0.001）；等效球镜度（SE）为（-0.43±1.64）D，较术前明显降低（t =-5.983，P <0.001）；角膜散光度为（1.92±0.85）D，与术前差异无统计学意义（t =-0.68，P =0.506）；角膜内皮细胞密度为（1 893±826）个/mm2，较术前明显降低（t =4.048，P =0.001）。结论：采用不同大小透明角膜切口超声乳化术治疗RK术后白内障临床效果均较好，相对安全，建议RK角膜瘢痕为8 刀者可采用3.2 mm及以下透明角膜切口，12 刀者可采用2.2 mm及以下透明角膜切口，16刀者可采用2.0 mm及以下透明角膜切口。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张景尚
	刘雪
	王进达
	熊瑛
	李婧
	李晓霞
	赵晶
	万修华

关键词 ：超声乳化白内障吸除术, 放射状角膜切开术, 人工晶状体, 角膜瘢痕

Abstract：

Objective: To evaluate the clinical effect of phacoemulsification with different sizes of clear corneal incisions in cataract after radial keratotomy (RK). Methods: This retrospective case series study from January 2011 to August 2015, included 16 cases (26 eyes) of cataract patients with a history of RK more than 10 years. Three cases (6 eyes) had 8 RK incisions, 8 cases (12 eyes) had 12 RK incisions, and 5 cases (8 eyes) had 16 RK incisions. All phacoemulsification and intraocular lens (IOL) implantations were performed through clear corneal incisions made by the same surgeon. For the cases with 8 RK incisions,4 eyes had a 3.2 mm clear corneal incisions and 2 eyes had a 3.0 mm clear corneal incisions. For the cases with 12 RK incisions, 4 eyes had a 3.2 mm clear corneal incision and 8 eyes had a 2.2 mm clear corneal incisions. For the cases with 16 RK incisions, 5 eyes had a 3.2 mm clear corneal incision and 3 eyes had a 2.0 mm clear corneal incisions. Dehiscence of the RK incisions, management of complications,and postoperative visual acuity recovery were observed 1 day, 1 week, and 1, 3, 6, 12, 24, and 36 months after surgery. The preoperative and postoperative parameters were analyzed by paired t -tests. Results:In the cataract surgery, no RK incisions dehisced in any of the eyes with 8 or 12 RK incisions, and all of the clear corneal incisions closed well. For cataract surgery of 6 eyes following RK with 16 clear corneal
incisions, there was also no dehiscence of the RK incisions, but for RK incisions adjacent to the clear corneal incision, two eyes dehisced. The dehiscence of RK incisions was closed by injecting an air bubble into the anterior chamber. The follow-up time (mean±SD) was 12.9±11.6 months. During the follow-up,
the incisions closed well in all of the 26 eyes, and no new dehiscence of RK incisions occurred. In the last follow-up, the best corrected visual acuity (BCVA) was 0.19±0.12, which was better than the preoperative BCVA (t =-6.913, P <0.001). The spherical equivalent refraction was -0.43±1.64 diopter (D), which was less than preoperative value (t =-5.983, P <0.001). The corneal astigmatism was 1.92±0.85 D, and there was no difference with preoperative value (t =-0.68, P =0.506). The corneal endothelial cell density was 1 893±826 cells/mm2, which was less than preoperative value (t =4.048, P =0.001). Conclusions:Phacoemulsification and IOL implantation with clear corneal incisions in cataract patients after RK was effective and safe. Better results may be achieved with 3.2 mm or smaller clear corneal incisions in cataract surgery after RK with 8 incisions, 2.2 mm or smaller clear corneal incisions after RK with 12 incisions,and 2.0 mm or smaller clear corneal incisions after RK with 16 incisions.

Key words： phacoemulsification radial keratotomy intraocular lenses corneal incisions

收稿日期: 2017-01-15

基金资助:

北京市科技新星（H020821380190，Z131102000413025）；国务院妇女儿童工作委员会课题（2014108）

通讯作者: 万修华，Email：xiuhuawan@163.com

引用本文:

张景尚,刘雪,王进达,熊瑛,李婧,李晓霞,赵晶,万修华. 不同大小透明角膜切口超声乳化术治疗放射状角膜切开术后白内障[J]. 中华眼视光学与视觉科学杂志, 2017, 19(10): 600-605. Jingshang Zhang,Xue Liu,Jinda Wang,Ying Xiong,Jing Li,Xiaoxia Li,Jing Zhao,Xiuhua Wan. Phacoemulsification with different sizes of clear corneal Incisions in Cataract after Radial Keratotomy. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(10): 600-605. DOI: 10.3760/cma.j.issn.1674-845X.2017.10.004

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2017.10.004 或 https://www.cjoovs.com/CN/Y2017/V19/I10/600

[1]	Sato T, Akiyama K, Shibata H. A new surgical approach to myopia. Am J Ophthalmol, 1953, 36(61): 823-829.
[1]	Sato T, Akiyama K, Shibata H. A new surgical approach to myopia. Am J Ophthalmol, 1953, 36(61): 823-829.
[2]	Peacock LW, Slade SG, Martiz J, et al. Ocular integrity after refractive procedures. Ophthalmology, 1997, 104(7): 1079-1083.
[2]	Peacock LW, Slade SG, Martiz J, et al. Ocular integrity after refractive procedures. Ophthalmology, 1997, 104(7): 1079-1083.
[3]	Larson BC, Kremer FB, Eller AW, et al. Quantitated trauma following radial keratotomy in rabbits. Ophthalmology, 1983,90(6): 660-667.
[4]	宋慧, 汤欣. 放射状角膜切开术后行超声乳化白内障吸除术中发生伤口裂开一例. 中华眼科杂志, 2009, 45(9): 848-849.DOI: 10.3760/cma.j.issn.0412-4081.2009.09.021.
[5]	Day A, Seward H. Delayed radial keratotomy dehiscence following uneventful phacoemulsification cataract surgery. Eye(London), 2007, 21(6): 886-887. DOI:10.1038/sj.eye.6702762.
[6]	Freeman M, Kumar V, Ramanathan US, et al. Dehiscence of radial keratotomy incision during phacoemulsification. Eye(London), 2004, 18(1): 101-103. DOI:10.1038/sj.eye.6700526.
[3]	Larson BC, Kremer FB, Eller AW, et al. Quantitated trauma following radial keratotomy in rabbits. Ophthalmology, 1983,90(6): 660-667.
[4]	宋慧, 汤欣. 放射状角膜切开术后行超声乳化白内障吸除术中发生伤口裂开一例. 中华眼科杂志, 2009, 45(9): 848-849.DOI: 10.3760/cma.j.issn.0412-4081.2009.09.021.
[5]	Day A, Seward H. Delayed radial keratotomy dehiscence following uneventful phacoemulsification cataract surgery. Eye(London), 2007, 21(6): 886-887. DOI:10.1038/sj.eye.6702762.
[6]	Freeman M, Kumar V, Ramanathan US, et al. Dehiscence of radial keratotomy incision during phacoemulsification. Eye(London), 2004, 18(1): 101-103. DOI:10.1038/sj.eye.6700526.
[7]	Behl S, Kothari K. Rupture of a radial keratotomy incision after 11 years during clear corneal phacoemulsification. J Cataract Refract Surg, 2001, 27(7): 1132-1134.
[7]	Behl S, Kothari K. Rupture of a radial keratotomy incision after 11 years during clear corneal phacoemulsification. J Cataract Refract Surg, 2001, 27(7): 1132-1134.
[8]	Budak K, Friedman NJ, Koch DD. Dehiscence of a radial keratotomy incision during clear corneal cataract surgery. J Cataract Refract Surg, 1998, 24(2): 278-280.
[9]	刘雪, 王进达, 张景尚, 等. 3.2 mm透明角膜切口超声乳化术治疗放射状角膜切开术后白内障的效果及安全性. 眼科,2015, 24(6): 373-376. DOI: 10.13281/j.cnki.issn.1004-4469.2015.
[8]	Budak K, Friedman NJ, Koch DD. Dehiscence of a radial keratotomy incision during clear corneal cataract surgery. J Cataract Refract Surg, 1998, 24(2): 278-280.
[9]	刘雪, 王进达, 张景尚, 等. 3.2 mm透明角膜切口超声乳化术治疗放射状角膜切开术后白内障的效果及安全性. 眼科,2015, 24(6): 373-376. DOI: 10.13281/j.cnki.issn.1004-4469.2015.
06	006.
[10]	章伟利, 李金瑛. 白内障超声乳化致放射状角膜切开术后角膜瘢痕裂开一例. 中华眼视光学与视觉科学杂志, 2015,17(1): 60. DOI: 10.3760/cma.j.issn.1674-845X.2015.01.015.
06	006.
[10]	章伟利, 李金瑛. 白内障超声乳化致放射状角膜切开术后角膜瘢痕裂开一例. 中华眼视光学与视觉科学杂志, 2015,17(1): 60. DOI: 10.3760/cma.j.issn.1674-845X.2015.01.015.
[11]	Luttrull JK, Jester JV, Smith RE. The effect of radial keratotomy on ocular integrity in an animal model. Arch Ophthalmol, 1982,100(2): 319-320.
[11]	Luttrull JK, Jester JV, Smith RE. The effect of radial keratotomy on ocular integrity in an animal model. Arch Ophthalmol, 1982,100(2): 319-320.
[12]	Waring GO, Steinberg EB, Wilson LA. Slit-lamp microscopic appearance of corneal wound healing after radial keratotomy.Am J Ophthalmol, 1985, 100(1): 218-224.
[12]	Waring GO, Steinberg EB, Wilson LA. Slit-lamp microscopic appearance of corneal wound healing after radial keratotomy.Am J Ophthalmol, 1985, 100(1): 218-224.
[13]	Fyodorov SN, Durnev VV. Operation of dosaged dissection of corneal circular ligament in cases of myopia of mild degree.Ann Ophthalmol, 1979, 11(12): 1885-1890.
[13]	Fyodorov SN, Durnev VV. Operation of dosaged dissection of corneal circular ligament in cases of myopia of mild degree.Ann Ophthalmol, 1979, 11(12): 1885-1890.
[14]	Binder PS, Nayak SK, Deg JK, et al. An ultrastructural and histochemical study of long-term wound healing after radial keratotomy. Am J Ophthalmol, 1987, 103(3 Pt 2): 432-440.
[14]	Binder PS, Nayak SK, Deg JK, et al. An ultrastructural and histochemical study of long-term wound healing after radial keratotomy. Am J Ophthalmol, 1987, 103(3 Pt 2): 432-440.
[15]	Wilczynski M, Supady E, Loba P, et al. Evaluation of surgically induced astigmatism after coaxial phacoemulsification through 1.8 mm microincision and standard phacoemulsification through 2.75 mm incision. Klin Oczna, 2011, 113(10-12): 314-320.
[15]	Wilczynski M, Supady E, Loba P, et al. Evaluation of surgically induced astigmatism after coaxial phacoemulsification through 1.8 mm microincision and standard phacoemulsification through 2.75 mm incision. Klin Oczna, 2011, 113(10-12): 314-320.