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目的比较双手微切口与常规切口超声乳化手术后角膜屈光变化的差异。设计前瞻性病例系列。研究对象102例(122眼)超声乳化白内障手术患者。方法58例(66眼)双手微切口手术患者(组1)及44例(56眼)常规切口手术患者(组2)在术前、术后1周、1个月、3个月行TMS-4型角膜地形图检查,比较角膜曲率的变化。主要指标角膜中心区3mm和6mm范围内角膜曲率平均值。结果术后3个月组1与组2角膜中心区3mm比较:切口半经线(10:30)角膜曲率平均值与术前差值,组1、组2分别为(-0.06±0.91)D、(-0.44±0.53)D(P=0.025)。经线分析:切口经线(10:30)角膜曲率平均值与术前差值,组1、组2分别为(-0.07±0.55)D、(-0.26±0.42)D(P=0.099)。直接手术源性散光分析:组1、组2分别为(0.22±0.59)D、(0.43±0.60)D(P=0.139)。术后3个月组1与组2角膜中心区6mm比较:切口半经线(10:30)角膜曲率平均值与术前差值,组1、组2分别为(-0.35±0.57)D、(-0.68±0.61)D(P=0.022)。经线分析:切口经线(10:30)角膜曲率平均值与术前差值,组1、组2分别为(-0.32±0.71)D、(-0.34±0.42)D(P=0.909)。直接手术源性散光分析:组1、组2分别为(0.33±0.98)D、(0.50±0.60)D(P=0.342)。术后1周、1个月切口半经线、经线及手术源性散光两组比较均有统计学意义(P均﹤0.05)。结论双手微切口较常规切口超声乳化手术的角膜屈光改变更小。
Objective To compare the differences of corneal refractive changes between two-hand micro-incision and conventional incision phacoemulsification. Design prospective case series. The study included 102 patients (122 eyes) with phacoemulsification cataract surgery. Methods 58 patients (66 eyes) underwent micro-incision surgery (group 1) and 44 patients (56 eyes) underwent conventional incision surgery (group 2) underwent TMS- Type 4 corneal topography examination, changes in corneal curvature. The main indicators corneal center 3mm and 6mm range of corneal curvature average. Results The mean corneal curvature at 10:30 after incision was 3 months compared with that of group 2 at 3 months after operation. The difference between the mean corneal curvature and the preoperative difference in group 1 and group 2 was (-0.06 ± 0.91) D, (-0.44 ± 0.53) D (P = 0.025). The warp analysis showed that mean corneal curvature at 10:30 incision (preoperative) and preoperative difference were (-0.07 ± 0.55) D and (-0.26 ± 0.42) D, respectively (P = 0.099). Direct surgical astigmatism analysis: group 1, group 2 were (0.22 ± 0.59) D, (0.43 ± 0.60) D (P = 0.139). The mean corneal curvature at 10:30 after incision was compared with that before operation in group 1 and group 2 (-0.35 ± 0.57) D, ( -0.68 ± 0.61) D (P = 0.022). The warp analysis showed that the average corneal curvature at the incision (10:30) and preoperative difference were (-0.32 ± 0.71) D and (-0.34 ± 0.42) D, respectively (P = 0.909). Direct surgical astigmatism analysis: group 1, group 2 were (0.33 ± 0.98) D, (0.50 ± 0.60) D (P = 0.342). The 1-month and 1-month incision semilimer, warp and surgical astigmatism were statistically significant (P <0.05). Conclusions Both hands micro-incision less corneal refractive change than conventional incision phacoemulsification.