两种手法劈核方法在小切口白内障囊外摘除术中的应用
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摘要
目的:探讨两种手法劈核方法在小切口白内障囊外摘除术中的临床效果。方法:对143例184眼Ⅳ级及以上核采用小切口白内障囊外摘除+人工晶状体植入术,术中随机采用手法勾刀劈核法(92眼)或双刀劈核法(92眼),观察比较术中后囊膜破裂情况,观察比较患者术后1d,1wk,1mo的视力、角膜水肿、角膜散光情况。结果:术中后囊膜破裂情况,勾刀劈核法(10眼)与双刀劈核法(1眼)差异有统计学意义(P<0.05);术后1d视力比较勾刀劈核法(92眼,0.380±0.105)与双刀劈核法(92眼,0.420±0.095)差异有统计学意义(P<0.05);术后1wk视力比较勾刀劈核法(84眼,0.480±0.123)与双刀劈核法(86眼,0.520±0.085)差异有统计学意义(P<0.05);术后1mo视力比较勾刀劈核法(60眼,0.610±0.083)与双刀劈核法(52眼,0.643±0.072)差异无统计学意义;术后1d,1wk,1mo的角膜水肿、角膜散光情况勾刀劈核法与双刀劈核法差异无统计学意义。结论:勾刀劈核法与双刀劈核法在小切口白内障囊外摘除+人工晶状体植入术中的应用均能有效治疗Ⅳ级及以上核的白内障,两组最主要的差异在于后囊膜破裂的情况,导致视力恢复有快慢之别,术后角膜水肿及散光情况两组无明显差异。
AIM:To research clinical effect of two manual chopping methods for small incision extracapsular cataract extraction.METHODS:We observed 143 cases(184 eyes) with grade IV or higher taken the small incision cataract extraction and intraocular lens implantation.Patients were given randomly knifed chopping with closed hook(92eyes) or double knifed chopping(92 eyes).The intra —operative posterior capsule rupture was observed and compared.At 1d,1wk and 1mo postoperatively,visual acuity,corneal edema and corneal astigmatism were observed and analyzed.RESULTS:There were 10 eyes in patients accepting knifed chopping with closed hook with intra-operative posterior capsule rupture and 1 eye in patients accepting double knifed chopping.The difference between the two groups was statistically significant.The visual acuity of patients accepting knifed chopping with closed hook(92eyes) at 1d postoperatively was 0.380±0.105,and that of patients accepting double knifed chopping(92 eyes) was0.420±0.095;the difference between the two groups was statistically significant.The visual acuity of patients accepting knifed chopping with closed hook(84 eyes) at1 wk postoperatively was 0.480±0.123,and that of patients accepting double knifed chopping(86 eyes) was 0.520±0.085;the difference between the two groups was statistically significant.The visual acuity of patients accepting knifed chopping with closed hook(60 eyes) at1 mo postoperatively was 0.610±0.083,and that of patients accepting double knifed chopping(52 eyes) was 0.643±0.072;the difference between the two groups was not statistically significant.The differences on corneal edema and corneal astigmatism between the two methods at 1d,1wk and 1mo postoperatively were not statistically significant.CONCLUSION:The application of knifed chopping with closed hook and double knifed chopping in small incision extracapsular cataract extraction and intraocular lens implantation can effectively treat with cataract with grade IV or higher.The most important difference is on the capsular rupture which causes the different recover periods after the two operations.There was no significant difference on postoperative corneal edema and astigmatism.
AIM:To research clinical effect of two manual chopping methods for small incision extracapsular cataract extraction.METHODS:We observed 143 cases(184 eyes) with grade IV or higher taken the small incision cataract extraction and intraocular lens implantation.Patients were given randomly knifed chopping with closed hook(92eyes) or double knifed chopping(92 eyes).The intra —operative posterior capsule rupture was observed and compared.At 1d,1wk and 1mo postoperatively,visual acuity,corneal edema and corneal astigmatism were observed and analyzed.RESULTS:There were 10 eyes in patients accepting knifed chopping with closed hook with intra-operative posterior capsule rupture and 1 eye in patients accepting double knifed chopping.The difference between the two groups was statistically significant.The visual acuity of patients accepting knifed chopping with closed hook(92eyes) at 1d postoperatively was 0.380±0.105,and that of patients accepting double knifed chopping(92 eyes) was0.420±0.095;the difference between the two groups was statistically significant.The visual acuity of patients accepting knifed chopping with closed hook(84 eyes) at1 wk postoperatively was 0.480±0.123,and that of patients accepting double knifed chopping(86 eyes) was 0.520±0.085;the difference between the two groups was statistically significant.The visual acuity of patients accepting knifed chopping with closed hook(60 eyes) at1 mo postoperatively was 0.610±0.083,and that of patients accepting double knifed chopping(52 eyes) was 0.643±0.072;the difference between the two groups was not statistically significant.The differences on corneal edema and corneal astigmatism between the two methods at 1d,1wk and 1mo postoperatively were not statistically significant.CONCLUSION:The application of knifed chopping with closed hook and double knifed chopping in small incision extracapsular cataract extraction and intraocular lens implantation can effectively treat with cataract with grade IV or higher.The most important difference is on the capsular rupture which causes the different recover periods after the two operations.There was no significant difference on postoperative corneal edema and astigmatism.
引文
1葛坚.眼科学.北京:人民卫生出版社2005:214-219
2 刘亚东,张黎.两种白内障摘出术后治疗硬核白内障的疗效比较.眼科新进展2005;25(1):68-69
3 文燕梅,李丽辉,罗云伟.超声乳化术与中切口白内障囊外摘除术的疗效对比.国际眼科杂志2015;15(2):262-265
4 高业明,邰平,査汝勤.小切口白内障囊外摘除并人工晶体植入治疗老年性白内障的临床观察.中外医学研究2012;10(5):22-23
5 费玉喜,张志娟,吴春松,等.小切口非超声乳化白内障手术治疗硬核白内障的临床观察.现代医院2013;13(2):34-36
6 杨金永.小切口白内障囊外摘除联合人工晶状体植入术疗效观察.中国继续医学教育2015;7(22):75-76
7 曾龙飞,解忠祥.无缝线小切口白内障囊外摘除术治疗硬核白内障的疗效.实用临床医学2015;10:62-63
8 赵堪兴,杨培增.眼科学.第8版.北京:人民卫生出版社2013:336-342
9 Cook C,Carrara H,Myer L.P hacoemulsification versus manual small incision cataract surgery in South Africa.S Afr Med J 2012;102(6):537-540
10 蓝庆豪,黄冲.小切口白内障摘出术中后囊破裂的分析及处理.中华眼外伤职业眼病杂志2014;36(1):48-50
2 刘亚东,张黎.两种白内障摘出术后治疗硬核白内障的疗效比较.眼科新进展2005;25(1):68-69
3 文燕梅,李丽辉,罗云伟.超声乳化术与中切口白内障囊外摘除术的疗效对比.国际眼科杂志2015;15(2):262-265
4 高业明,邰平,査汝勤.小切口白内障囊外摘除并人工晶体植入治疗老年性白内障的临床观察.中外医学研究2012;10(5):22-23
5 费玉喜,张志娟,吴春松,等.小切口非超声乳化白内障手术治疗硬核白内障的临床观察.现代医院2013;13(2):34-36
6 杨金永.小切口白内障囊外摘除联合人工晶状体植入术疗效观察.中国继续医学教育2015;7(22):75-76
7 曾龙飞,解忠祥.无缝线小切口白内障囊外摘除术治疗硬核白内障的疗效.实用临床医学2015;10:62-63
8 赵堪兴,杨培增.眼科学.第8版.北京:人民卫生出版社2013:336-342
9 Cook C,Carrara H,Myer L.P hacoemulsification versus manual small incision cataract surgery in South Africa.S Afr Med J 2012;102(6):537-540
10 蓝庆豪,黄冲.小切口白内障摘出术中后囊破裂的分析及处理.中华眼外伤职业眼病杂志2014;36(1):48-50