2.4 mm透明角膜单切口超声乳化白内障吸出术对角膜的影响
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摘要
目的比较单切口超声乳化白内障吸出术(phacoemulsification aspiration,PEA)与双切口PEA对角膜的影响。方法连续性非随机病例对照研究。本研究纳入2016年8月至2017年12月在南通大学附属医院眼科医院行2. 4 mm透明角膜单切口PEA联合人工晶状体植入术的年龄相关性白内障(age-related cataract,ARC)患者(100眼)(单切口组),并选择此时间段内与之眼轴、前房深度、晶状体核混浊等眼部和全身情况相匹配的行透明角膜双切口PEA联合人工晶状体植入术的患者(100眼)(双切口组)。比较两组患者术中总超声时间、累积释放能量(cumulative dissipated energy,CDE)等,术后1周、1个月、3个月裸眼视力(uncorrected distance visual acuity,UDVA)及矫正远视力(corrected distance visual acuity,CDVA),10 mm范围内角膜体积(10 mmcorneal volume,10 mm-CV),中央角膜厚度(central corneal thickness,CCT),角膜内皮细胞计数及形态等参数。结果单切口组术中总超声时间、CDE分别为(27. 84±19. 61) s、5. 15±3. 70,双切口组分别为(23. 62±16. 55) s、4. 77±3. 65,两组比较差异均无统计学意义(均为P> 0. 05);术后1周,单切口组的UDVA和CDVA均高于双切口组,差异均有统计学意义(均为P <0. 05)。术后1个月、3个月两组间差异均无统计学意义(均为P> 0. 05)。术后1周,单切口组10 mm-CV及CCT均小于双切口组,差异均有统计学意义(均为P <0. 05),术后1个月、3个月两组间差异均无统计学意义(均为P> 0. 05)。单切口组术后1周、1个月、3个月角膜内皮细胞丢失率分别为(6. 82±3. 39)%、(7. 05±4. 22)%、(7. 06±4. 37)%,双切口组角膜内皮细胞丢失率分别为(8. 08±3. 31)%、(8. 28±4. 28)%、(8. 37±4. 85)%,两组术后各时间点差异均有统计学意义(均为P <0. 05)。结论早期ARC患者行单切口PEA对角膜的创伤程度较双切口PEA轻,术后恢复快,早期可拥有更好的视觉质量。
Objective To compare the effect on cornea in patients undergoing single-incision with two-incision phacoemulsification.M ethods Continuous nonrandomized case-control study.This study included patients with age-related cataract( ARC)( 100 eyes) who underwent 2.4 mm clear corneal single-incision phacoemulsification combined with intraocular lens implantation in the Ophthalmological Hospital,Affiliated Hospital of Nantong University from August 2016 to December 2017.The eye conditions such as axial length,anterior chamber depth,nuclear opacities and general conditions were matched with patients( 100 eyes) undergoing two-incision phacoemulsification combined with intraocular lens implantation.Intraoperative ultrasonic total time,cumulative dissipated energy( CDE),etc.uncorrected and corrected distance visual acuity( UDVA,CDVA),10 mm-corneal volume( 10 mm-CV),central corneal thickness( CCT),corneal endothelial cell counts and morphology,etc.at 1 week,1 month and 3 months postoperatively were compared.SPSS22 statistical software was used for statistical analysis.Results The ultrasonic total time,and CDE in single-incision group were( 27.84 ± 19.61) s and 5.15 ±3.70,these parameters in two-incisions group were( 23.62 ± 16.55) s and 4.77± 3.65,the differences were no statistically significant( all P > 0.05).At postoperative week 1,UDVA and CDVA were better in the single-incision group compared with two-incision group( all P < 0.05),but not at 1 month and 3 months( all P >0.05).At postoperative week 1,10 mm-CV and CCT were significantly smaller in the single-incision group compared with two-incision group( all P < 0.05),but the differences were ameliorated at 1 month and 3 months postoperatively( all P > 0.05).The endothelium corneal loss( ECL) at 1 week,1 month and 3 months postoperative was( 6.82 ± 3.39) %,( 7.05 ± 4.22) %,( 7.06 ± 4.37) % in single-incision group and( 8.08 ± 3.31) %,( 8.28 ± 4.28) %,( 8.37 ± 4.85) %in two-incision group and the difference was statistically significant at any follow-up point( all P < 0.05).Conclusion Single-incision phacoemulsification has the advantages of less trauma to the cornea,faster recovery and better early visual outcomes compared with the two-incision technique in patient with early ARC.
Objective To compare the effect on cornea in patients undergoing single-incision with two-incision phacoemulsification.M ethods Continuous nonrandomized case-control study.This study included patients with age-related cataract( ARC)( 100 eyes) who underwent 2.4 mm clear corneal single-incision phacoemulsification combined with intraocular lens implantation in the Ophthalmological Hospital,Affiliated Hospital of Nantong University from August 2016 to December 2017.The eye conditions such as axial length,anterior chamber depth,nuclear opacities and general conditions were matched with patients( 100 eyes) undergoing two-incision phacoemulsification combined with intraocular lens implantation.Intraoperative ultrasonic total time,cumulative dissipated energy( CDE),etc.uncorrected and corrected distance visual acuity( UDVA,CDVA),10 mm-corneal volume( 10 mm-CV),central corneal thickness( CCT),corneal endothelial cell counts and morphology,etc.at 1 week,1 month and 3 months postoperatively were compared.SPSS22 statistical software was used for statistical analysis.Results The ultrasonic total time,and CDE in single-incision group were( 27.84 ± 19.61) s and 5.15 ±3.70,these parameters in two-incisions group were( 23.62 ± 16.55) s and 4.77± 3.65,the differences were no statistically significant( all P > 0.05).At postoperative week 1,UDVA and CDVA were better in the single-incision group compared with two-incision group( all P < 0.05),but not at 1 month and 3 months( all P >0.05).At postoperative week 1,10 mm-CV and CCT were significantly smaller in the single-incision group compared with two-incision group( all P < 0.05),but the differences were ameliorated at 1 month and 3 months postoperatively( all P > 0.05).The endothelium corneal loss( ECL) at 1 week,1 month and 3 months postoperative was( 6.82 ± 3.39) %,( 7.05 ± 4.22) %,( 7.06 ± 4.37) % in single-incision group and( 8.08 ± 3.31) %,( 8.28 ± 4.28) %,( 8.37 ± 4.85) %in two-incision group and the difference was statistically significant at any follow-up point( all P < 0.05).Conclusion Single-incision phacoemulsification has the advantages of less trauma to the cornea,faster recovery and better early visual outcomes compared with the two-incision technique in patient with early ARC.
引文
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[3]JALIL A,STEEPLES L,SUBRAMANI S,BINDRA M S,DHAWA-HIR-SCALA F,PATTON N.Microincision cataract surgery combined with vitrectomy:a case series[J].Eye,2014,28(4):386-389.
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[6]KIM Y K,KIM Y W,WOO S J,PARK K H.Comparison of surgically-induced astigmatism after combined phacoemulsification and 23-gauge vitrectomy:2.2-mm vs.2.75-mm cataract surgery[J].Korean J Ophthalmol,2014,28(2):130-137.
[7]SETHI H S,SALUJA K,NAIK M P.Comparative analysis of phacoemulsification with 2.2-and 2.8-mm clear corneal incisions[J].Int Ophthalmol,2018,38(1):215-222.
[8]LUNDBERG B,JONSSON M,BEHNDIG A.Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery[J].Am J Ophthalmol,2005,139(6):1035-1341.
[9]YU Y,CHEN X,HUA H,WU M,LAI K,YAO K.Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification:a six-month follow-up[J].Clin Exp Ophthalmol,2016,44(6):472-480.
[10]YUEN K S,CHENG A C.Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery[J].Am J Ophthalmol,2005,140(6):1171.
[11]WARING G O,BOURNE W M,EDELHAUSER H F,KENYON KR.The corneal endothelium normal and pathologic structure and function[J].Ophthalmology,1982,89(6):531-590.
[12]TANEV I,TANEV V,KANELLOPOULOS A J.Nanosecond laserassisted cataract surgery:Endothelial cell study[J].J Cataract Refract Surg,2016,42(5):725-730.
[13]CALABUIG-GOENA M,LOPEZ-MIGUEL A,MARQUES-FER-NANDEZ V,COCO-MARTIN M B,IGLESIAS-CORTINAS D,MALDONADO M J.Early changes in corneal epithelial thickness after cataract surgery--pilot study[J].Curr Eye Res,2016,41(3):311-317.
[14]SUZUKI H,OKI K,TAKAHASHI K,SHIWA T,TAKAHASHI H.Functional evaluation of corneal endothelium by combined measurement of corneal volume alteration and cell density after phacoemulsification[J].J Cataract Refract Surg,2007,33(12):2077-2082.
[15]KAWAHARA A,KUROSAKA D,YOSHIDA A.Comparison of surgically induced astigmatism between one-handed and two-handed cataract surgery techniques[J].Clin Ophthalmol,2013,7(9):1967-1972.
[16]PACIFICO R L.Divide and conquer phacoemulsification One-handed variant[J].J Refract Surg,1992,18(5):513-517.
[17]ALPINS N.Astigmatism analysis by the Alpinsmethod[J].J Cataract Refract Surg,2001,27(1):31-49.
[18]CAN I,TAKMAZ T,YILDIZ Y,BAYHAN H A,SOYUGELEN G,BOSTANCI B.Coaxial,microcoaxial,and biaxial microincision cataract surgery:prospective comparative study[J].J Cataract Refract Surg,2010,36(5):740-746.
[19]ASFUROGLU Y,KEMER O E.Central corneal thickness and corneal volume changes in eyes with and without pseudoexfoliation after uneventful phacoemulsification[J].Int Ophthalmol,2018,[Epub ahead of print].
[20]HAYASHI K,MANABE S,YOSHIMURA K,KONDO H.Corneal endothelial damage after cataract surgery in eyes with pseudoexfoliation syndrome[J].J Cataract Refract Surg,2013,39(6):881-887.
[21]WALKOW T,ANDERS N,KLEBE S.Endothelial cell loss after phacoemulsification:Relation to preoperative and intraoperative parameters[J].J Cataract Refract Surg,2000,26(5):727-732.
[2]CZAJKA M P,FRAJDENBERG A,JOHANSSON B.Comparison of1.8-mm incision versus 2.75-mm incision cataract surgery in combined phacoemulsification and 23-gauge vitrectomy[J].Acta Ophthalmol,2016,94(5):507-513.
[3]JALIL A,STEEPLES L,SUBRAMANI S,BINDRA M S,DHAWA-HIR-SCALA F,PATTON N.Microincision cataract surgery combined with vitrectomy:a case series[J].Eye,2014,28(4):386-389.
[4]CZAJKA M P,FRAJDENBERG A,JOHANSSON B.Outcomes after combined 1.8-mm microincision cataract surgery and 23-gauge transconjunctival vitrectomy for posterior segment disease[J].Retina,2014,34(1):142-148.
[5]LUNDSTRM M.Endophthalmitis and incision construction[J].Curr Opin Ophthalmol,2006,179(1):68-71.
[6]KIM Y K,KIM Y W,WOO S J,PARK K H.Comparison of surgically-induced astigmatism after combined phacoemulsification and 23-gauge vitrectomy:2.2-mm vs.2.75-mm cataract surgery[J].Korean J Ophthalmol,2014,28(2):130-137.
[7]SETHI H S,SALUJA K,NAIK M P.Comparative analysis of phacoemulsification with 2.2-and 2.8-mm clear corneal incisions[J].Int Ophthalmol,2018,38(1):215-222.
[8]LUNDBERG B,JONSSON M,BEHNDIG A.Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery[J].Am J Ophthalmol,2005,139(6):1035-1341.
[9]YU Y,CHEN X,HUA H,WU M,LAI K,YAO K.Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification:a six-month follow-up[J].Clin Exp Ophthalmol,2016,44(6):472-480.
[10]YUEN K S,CHENG A C.Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery[J].Am J Ophthalmol,2005,140(6):1171.
[11]WARING G O,BOURNE W M,EDELHAUSER H F,KENYON KR.The corneal endothelium normal and pathologic structure and function[J].Ophthalmology,1982,89(6):531-590.
[12]TANEV I,TANEV V,KANELLOPOULOS A J.Nanosecond laserassisted cataract surgery:Endothelial cell study[J].J Cataract Refract Surg,2016,42(5):725-730.
[13]CALABUIG-GOENA M,LOPEZ-MIGUEL A,MARQUES-FER-NANDEZ V,COCO-MARTIN M B,IGLESIAS-CORTINAS D,MALDONADO M J.Early changes in corneal epithelial thickness after cataract surgery--pilot study[J].Curr Eye Res,2016,41(3):311-317.
[14]SUZUKI H,OKI K,TAKAHASHI K,SHIWA T,TAKAHASHI H.Functional evaluation of corneal endothelium by combined measurement of corneal volume alteration and cell density after phacoemulsification[J].J Cataract Refract Surg,2007,33(12):2077-2082.
[15]KAWAHARA A,KUROSAKA D,YOSHIDA A.Comparison of surgically induced astigmatism between one-handed and two-handed cataract surgery techniques[J].Clin Ophthalmol,2013,7(9):1967-1972.
[16]PACIFICO R L.Divide and conquer phacoemulsification One-handed variant[J].J Refract Surg,1992,18(5):513-517.
[17]ALPINS N.Astigmatism analysis by the Alpinsmethod[J].J Cataract Refract Surg,2001,27(1):31-49.
[18]CAN I,TAKMAZ T,YILDIZ Y,BAYHAN H A,SOYUGELEN G,BOSTANCI B.Coaxial,microcoaxial,and biaxial microincision cataract surgery:prospective comparative study[J].J Cataract Refract Surg,2010,36(5):740-746.
[19]ASFUROGLU Y,KEMER O E.Central corneal thickness and corneal volume changes in eyes with and without pseudoexfoliation after uneventful phacoemulsification[J].Int Ophthalmol,2018,[Epub ahead of print].
[20]HAYASHI K,MANABE S,YOSHIMURA K,KONDO H.Corneal endothelial damage after cataract surgery in eyes with pseudoexfoliation syndrome[J].J Cataract Refract Surg,2013,39(6):881-887.
[21]WALKOW T,ANDERS N,KLEBE S.Endothelial cell loss after phacoemulsification:Relation to preoperative and intraoperative parameters[J].J Cataract Refract Surg,2000,26(5):727-732.