论文部分内容阅读
目的评估超声针头斜面向下乳化劈裂技术的手术效果,探讨超声乳化术中角膜内皮细胞机械性损伤的机制。方法对251眼白内障施行超声乳化及人工晶体植入术。术中采用超声针头斜面向下乳化劈裂技术127眼(A组),其中Ⅱ级核28眼,Ⅲ级核69眼,Ⅳ～Ⅴ-级核30眼。采用传统的超声针头斜面向上乳化劈裂技术124眼(B组),其中Ⅱ级核31眼,Ⅲ级核65眼,Ⅳ～Ⅴ-级核28眼。对两组的累计能量复合参数及术后6个月角膜内皮细胞丢失率分别对照研究。结果A组累计能量复合参数:Ⅱ级核(2.7±0.5)秒;Ⅲ级核(11.9±2.1)秒;Ⅳ～Ⅴ-级核(30.2±8.1)秒。角膜内皮细胞丢失率:Ⅱ级核(5.1±0.6)%;Ⅲ级核(8.9±0.4)%;Ⅳ～Ⅴ-级核(12.5±1.6)%。B组累计能量复合参数:Ⅱ级核(2.6±0.4)秒;Ⅲ级核(12.2±2.5)秒;Ⅳ～Ⅴ-级核(31.7±8.9)秒。角膜内皮细胞丢失率:Ⅱ级核(5.0±0.5)%;Ⅲ级核(11.2±0.8)%;Ⅳ～Ⅴ-级核(20.6±1.4)%。Ⅱ级核组间差异无统计学意义(P>0.05),Ⅲ级核组间差异有统计学意义(P<0.05),Ⅳ～Ⅴ-级核组间差异有统计学意义(P<0.01)。结论超声乳化术中采用超声针头斜面向下乳化劈裂技术可有效地降低角膜内皮细胞的损失率。对于硬核白内障的超声乳化,采用此技术更有利于对角膜内皮细胞的保护。
OBJECTIVE: To evaluate the surgical effect of ultrasonic needle-tip downward emulsification and cleavage technique and to explore the mechanism of corneal endothelial cell mechanical injury during phacoemulsification. Methods 251 cases of cataract phacoemulsification and intraocular lens implantation. Intraoperative use of ultrasound needle oblique downward emulsification and cleavage of 127 eyes (A group), including 28 Ⅱ grade nucleus, Ⅲ grade 69 eyes, Ⅳ ~ Ⅴ-level nuclear 30 eyes. 124 eyes (group B) were treated with traditional ultrasonic needle oblique upward emulsification and cleavage technique, of which 31 eyes were grade Ⅱ, 65 eyes were Ⅲ and 28 eyes were Ⅳ ~ Ⅴ-grade. The cumulative energy composite parameters of the two groups and the corneal endothelial cell loss rate after 6 months were compared respectively. Results The cumulative energy complex parameters in group A were: grade Ⅱ (2.7 ± 0.5) second; grade Ⅲ (11.9 ± 2.1) second; Ⅳ ~ Ⅴ-grade (30.2 ± 8.1) second. Corneal endothelial cell loss rate: grade Ⅱ (5.1 ± 0.6)%; grade Ⅲ (8.9 ± 0.4)%; Ⅳ ~ Ⅴ-grade (12.5 ± 1.6)%. Group B cumulative energy composite parameters: Ⅱ grade nuclei (2.6 ± 0.4) seconds; Ⅲ grade nuclei (12.2 ± 2.5) seconds; Ⅳ ~ Ⅴ-grade nuclei (31.7 ± 8.9) seconds. The corneal endothelial cell loss rate was 5.0 ± 0.5% in grade Ⅱ, 11.2 ± 0.8% in grade Ⅲ and 20.6 ± 1.4% in grade Ⅳ-Ⅴ. There was no significant difference between the two groups (P> 0.05), the difference between the three groups was statistically significant (P <0.05), the difference between the groups of Ⅳ ~ Ⅴ-grade nuclear was statistically significant (P <0.01) . Conclusion Ultrasound phacoemulsification using oblique bevel face downward emulsification splitting technology can effectively reduce the loss rate of corneal endothelial cells. For phacoemulsification of hard nucleus cataract, using this technique is more conducive to the protection of corneal endothelial cells.