CAJ | 학술논문

目的比较高频脉冲能量模式与扭动能量模式在不同核硬度的白内障超声乳化吸除术中的应用.方法老年性白内障患者125例(133只眼),晶状体核硬度Ⅱ级34只眼,Ⅲ级48只眼,Ⅳ级51只眼(LOCS Ⅱ标准分级).按核级随机分为2组,分别采用高频脉冲、扭动能量模式行超声乳化白内障吸除联合后房型人工晶状体植入术,观察术中实际等效超声能量(total equivalent power,TEP),有效超声时间(effective phaco time,EPT),累计释放能量(cumulative dissipated energy,CDE)；比较术后角膜内皮计数,角膜厚度,角膜水肿和前节反应状态.结果 Ⅱ级核处理:高频脉冲组EPT和CDE显著高于扭动组(P＜0.05),其余各参数无显著差异.Ⅲ级核处理:高频脉冲组与扭动组EPT无显著差异,高频脉冲组CDE显著低于扭动组(13.38±2.85) vs (29.66±6.79),差异有统计学意义(P＜0.05).Ⅳ级核处理:高频脉冲组与扭动组EPT无显著差异,高频脉冲组CDE显著低于扭动组(23.26±10.76)s vs(34.23±15.99)s,差异有统计学意义(P＜0.05).高频脉冲能量在处理Ⅱ级和Ⅲ级核中,TEP、EPT、CDE无显著差异,扭动能量在处理Ⅲ级核,TEP、EPT、CDE均显著高于Ⅱ级核处理.两组患者术后1天及1周的角膜内皮丢失率和角膜水肿率差异无统计学意义,但术后1天,高频脉冲组的角膜厚度增加率显著低于扭动组(11.57±9.37)％vs (19.02±10.32)％,差异有统计学意义(P＜0.05).结论两种能量模式均能安全有效地处理各类硬度的晶体核.扭动能量处理软核效率高,具有超声时间短,累积释放能量低的特点.高频脉冲能量释放稳定,尤其在硬核中具有累积释放能量低,角膜内皮损伤小的优势.硬核、高龄或角膜内皮功能相对低下的患者选择高频脉冲模式可以增加手术安全性、提高早期康复满意度.
목적 비교고빈맥충능량모식여뉴동능량모식재불동핵경도적백내장초성유화흡제술중적응용.방법 노년성백내장환자125례(133지안),정상체핵경도Ⅱ급34지안,Ⅲ급48지안,Ⅳ급51지안(LOCS Ⅱ표준분급).안핵급수궤분위2조,분별채용고빈맥충、뉴동능량모식행초성유화백내장흡제연합후방형인공정상체식입술,관찰술중실제등효초성능량(total equivalent power,TEP),유효초성시간(effective phaco time,EPT),루계석방능량(cumulative dissipated energy,CDE)；비교술후각막내피계수,각막후도,각막수종화전절반응상태.결과 Ⅱ급핵처리:고빈맥충조EPT화CDE현저고우뉴동조(P＜0.05),기여각삼수무현저차이.Ⅲ급핵처리:고빈맥충조여뉴동조EPT무현저차이,고빈맥충조CDE현저저우뉴동조(13.38±2.85) vs (29.66±6.79),차이유통계학의의(P＜0.05).Ⅳ급핵처리:고빈맥충조여뉴동조EPT무현저차이,고빈맥충조CDE현저저우뉴동조(23.26±10.76)s vs(34.23±15.99)s,차이유통계학의의(P＜0.05).고빈맥충능량재처리Ⅱ급화Ⅲ급핵중,TEP、EPT、CDE무현저차이,뉴동능량재처리Ⅲ급핵,TEP、EPT、CDE균현저고우Ⅱ급핵처리.량조환자술후1천급1주적각막내피주실솔화각막수종솔차이무통계학의의,단술후1천,고빈맥충조적각막후도증가솔현저저우뉴동조(11.57±9.37)％vs (19.02±10.32)％,차이유통계학의의(P＜0.05).결론 량충능량모식균능안전유효지처리각류경도적정체핵.뉴동능량처리연핵효솔고,구유초성시간단,루적석방능량저적특점.고빈맥충능량석방은정,우기재경핵중구유루적석방능량저,각막내피손상소적우세.경핵、고령혹각막내피공능상대저하적환자선택고빈맥충모식가이증가수술안전성、제고조기강복만의도.
Objective To evaluate the efficacy and safety of phacoemulsification of different nucleus density using torsional modality and conventional hyper-pulse mode. Methods A total of 133eyes (125 patients) of different nucleus density level (LOCS Ⅱ criteria grade H 34 eyes,grade Ⅲ48 eyes,grade Ⅳ 51 eyes) were randomly assigned into 2 groups,torsional group (Tor group) and conventional ultrasound hyper-pulse motion group (HP group).All surgeries were performed by a single experienced surgeon.Intraoperative parameters were TEP (Total Equivalent Power),EPT (Effective Phaco Time) and CED (Cumulative Dissipated Energy) and surgical complications.Postoperative outcomes were evaluated by visual acuity,endothelial cell counting,and average central comeal thickness. Results Grade Ⅱ nucleus dealing:EPT and CDE of HP group was significantly higher than the Tor group (P ＜0.05).Grade Ⅲ and Grade Ⅳ nucleus dealing:EPT showed no difference between two groups,CDE of HP group was significantly lower than Tor group (13.38±2.85 vs 29.66±6.79 in Grade Ⅱ and 23.26±10.76 s vs 34.23±15.99s in Grand Ⅳ).There were no difference of central corneal cell loss rate and corneal edema rate on one day or one week after surgery between two groups.The corneal thickness increase was significantly less in HP group than Tor group (11.57±9.37％ vs 19.02± 10.32％,P ＜0.05). Conclusions Both torsional modality and conventional hyper-pulse mode can deal with all kinds of nucleus effectively and safely.Torsional modality is more efficacy and quick deal in soft cataract.Hyper-pulse mode is more stable and save accumulated energy in hard cataract.Hyper-pulse mode seems to be a safe and wise choice to dealing patients with hard nucleus,older age or lower corneal cell counting.