CAJ | 학술논문

目的：比较同轴微小切口白内障手术（ coaxial microincision cataract surgery ， MICS ）中三种劈核技术[乳化劈裂法（phaco-chop），分而治之法（divide-and-conquer），拦截劈裂法（ stop-and-chop ）]的疗效。 　　方法：本研究为前瞻性、随机临床病例研究。随机选择135例的年龄相关性白内障患者接受同轴微小切口白内障手术，首先根据LOCS Ⅲ分级标准按晶状体核混浊程度（ nuclear opacity ， NO ）分为三组：NO2组、NO3组及 NO4组，每组患者又依据术中使用劈核方式不同再分成三组：phaco-chop 组， divide-and-conquer 组及 stop-and-chop组。观察指标包括术前及术后1 mo最佳矫正视力（ best corrected visual acuity ， BCVA ）、中央角膜厚度（ central corneal thickness，CCT）及角膜内皮细胞计数（endothelial cell count， ECC），术中超声时间（ultrasound time，UST）、累积消耗能量（cumulative dissipated energy ，CDE）、灌注液消耗量（ esstimated fluied used ，EFU）及手术并发症。 　　结果：在晶状体核混浊程度为NO4组的同轴微小切口超声乳化术中phaco-chop组使用的UST，CDE和EFU均明显低于divide-and-conquer 组和stop-and-chop 组（ P＜0.05），且该组术后1 mo 时角膜内皮丢失率也明显低于divide-and-conquer组和stop-and-chop组（ P＜0．05）。但术后1 mo时在不同晶状体核混浊程度分组中三种劈核方式的BCVA及CCT无明显差异（ P＞0．05）。 　　结论：同轴微小切口白内障手术中三种不同的劈核方式针对轻度和中度核混浊白内障都有良好的疗效。但在重度核混浊白内障中phaco-chop技术显示出更好的超声乳化效率、更少的角膜内皮损伤。
목적：비교동축미소절구백내장수술（ coaxial microincision cataract surgery ， MICS ）중삼충벽핵기술[유화벽렬법（phaco-chop），분이치지법（divide-and-conquer），란절벽렬법（ stop-and-chop ）]적료효。 　　방법：본연구위전첨성、수궤림상병례연구。수궤선택135례적년령상관성백내장환자접수동축미소절구백내장수술，수선근거LOCS Ⅲ분급표준안정상체핵혼탁정도（ nuclear opacity ， NO ）분위삼조：NO2조、NO3조급 NO4조，매조환자우의거술중사용벽핵방식불동재분성삼조：phaco-chop 조， divide-and-conquer 조급 stop-and-chop조。관찰지표포괄술전급술후1 mo최가교정시력（ best corrected visual acuity ， BCVA ）、중앙각막후도（ central corneal thickness，CCT）급각막내피세포계수（endothelial cell count， ECC），술중초성시간（ultrasound time，UST）、루적소모능량（cumulative dissipated energy ，CDE）、관주액소모량（ esstimated fluied used ，EFU）급수술병발증。 　　결과：재정상체핵혼탁정도위NO4조적동축미소절구초성유화술중phaco-chop조사용적UST，CDE화EFU균명현저우divide-and-conquer 조화stop-and-chop 조（ P＜0.05），차해조술후1 mo 시각막내피주실솔야명현저우divide-and-conquer조화stop-and-chop조（ P＜0．05）。단술후1 mo시재불동정상체핵혼탁정도분조중삼충벽핵방식적BCVA급CCT무명현차이（ P＞0．05）。 　　결론：동축미소절구백내장수술중삼충불동적벽핵방식침대경도화중도핵혼탁백내장도유량호적료효。단재중도핵혼탁백내장중phaco-chop기술현시출경호적초성유화효솔、경소적각막내피손상。
AIM: To compare the efficiency of coaxial micro -incision cataract surgery ( MICS ) performed by 3 phacoemulsification techniques ( phaco-chop, divide-and-conquer and stop-and-chop) . METHODS:It was a perspective and randomized clinical trial.Totally 135 patients with age-related cataract were selected randomly and underwent MICS.According to the lens nuclear opacity ( NO) of LOCSⅢ grading standards, it can be divided into 3 groups as NO2, NO3 and NO4 group. All groups were randomly subdivided into 3 groups ( phaco-chop, divide-and-conquer and stop-and-chop group ) . The observation target included best -corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell count (ECC) before operation and 1mo postoperation, ultrasound time ( UST ), cumulative dissipated energy ( CDE ) , estimated fluied used ( EFU) in operation and complications. RESULTS:In lens nuclear opacity NO4 coaxial micro-incision phacoemulsification, phaco-chop group showed significantly less UST, CDE and EFU than the divide-and-conquer and stop-and-chop groups ( P<0.05 ) and the ratio of endothelial cell loss was significantly lower in the phaco-chop group than in the divide-and-conquer and stop-and-chop groups 1mo after surgery ( P<0.05). However, after 1mo surgery, BCVA and CCT among three chop technique groups in different lens nuclear opacity groups had no significant differences (P>0.05). CONCLUSION: All 3 techniques may be effective for coaxialmicroincision cataract surgery in mild and moderate nuclear opacity cataracts. However, in eyes with severe nuclear opacity cataract, the phaco-chop technique can be more effective for phacoemulsification, and less corneal endothelial damage.