CAJ | 학술논문

目的：对不同手术方法治疗青光眼术后硬核白内障的临床疗效和安全性进行观察和分析。方法选取2009年9月-2013年4月曲靖市第二人民医院收治的青光眼手术后硬核白内障患者100例作为研究对象，按不同治疗方法分为观察组和对照组，其中观察组54例（75眼），对照组46例（61眼）。观察组患者应用巩膜隧道小切口超声劈核后手法娩出核进行治疗，对照组患者应用透明角膜切口超声乳化碎核进行治疗。对所有患者随访3～6个月，观察和记录患者手术前、后视力，前房深度，眼压和角膜内皮细胞平均计数的变化及不良反应。结果2组患者视力均较治疗前显著改善（P ＜0．05），但2组间差异无统计学意义（P ＞0．05）；2组患者前房深度分级显著优于治疗前（P ＜0．05），且治疗后观察组患者的前房深度分级显著优于对照组（P ＜0．05）；2组患者治疗后的眼压与治疗前的差异无统计学意义（P ＞0．05），2组间的差异也无统计学意义（P ＞0．05）；观察组患者角膜内皮细胞密度下降不显著（P ＞0．05），而对照组则下降显著（P ＜0．05），观察组患者治疗后的角膜内皮细胞密度显著高于对照组（P ＜0．05）；2组患者术后的不良反应发生率分别为21．33％（16/75）和21．31％（13/61），经对症治疗后均得到控制和恢复，2组患者不良反应情况差异无统计学意义（P ＞0．05）。结论应用巩膜隧道小切口超声劈核后手法娩出核治疗青光眼术后硬核白内障，可有效改善患者视力和前房深度，安全性较高，且在改善前房深度和减少角膜细胞损伤方面优于超声乳化碎核术，值得临床推广应用。
목적：대불동수술방법치료청광안술후경핵백내장적림상료효화안전성진행관찰화분석。방법선취2009년9월-2013년4월곡정시제이인민의원수치적청광안수술후경핵백내장환자100례작위연구대상，안불동치료방법분위관찰조화대조조，기중관찰조54례（75안），대조조46례（61안）。관찰조환자응용공막수도소절구초성벽핵후수법면출핵진행치료，대조조환자응용투명각막절구초성유화쇄핵진행치료。대소유환자수방3～6개월，관찰화기록환자수술전、후시력，전방심도，안압화각막내피세포평균계수적변화급불량반응。결과2조환자시력균교치료전현저개선（P ＜0．05），단2조간차이무통계학의의（P ＞0．05）；2조환자전방심도분급현저우우치료전（P ＜0．05），차치료후관찰조환자적전방심도분급현저우우대조조（P ＜0．05）；2조환자치료후적안압여치료전적차이무통계학의의（P ＞0．05），2조간적차이야무통계학의의（P ＞0．05）；관찰조환자각막내피세포밀도하강불현저（P ＞0．05），이대조조칙하강현저（P ＜0．05），관찰조환자치료후적각막내피세포밀도현저고우대조조（P ＜0．05）；2조환자술후적불량반응발생솔분별위21．33％（16/75）화21．31％（13/61），경대증치료후균득도공제화회복，2조환자불량반응정황차이무통계학의의（P ＞0．05）。결론응용공막수도소절구초성벽핵후수법면출핵치료청광안술후경핵백내장，가유효개선환자시력화전방심도，안전성교고，차재개선전방심도화감소각막세포손상방면우우초성유화쇄핵술，치득림상추엄응용。
Objectives To observe and analyze the efficacy and safety of the different opera-tion methods in the treatment of hard nucleus cataract after glaucoma surgery.Methods 100 pa-tients with hard nucleus cataract after glaucoma operation were selected.According to the different treatment methods,the patients were divided into the observation group (n =54,75 eyes)and the control group (n =46,61 eyes).The observation group was treated with manual nuclear delivery after ultrasonic chopping nucleus through small scleral tunnel incision,while the control group was treated with the phacoemulsification through clarity corneal incision.All the patients were followed up for 3 to 6 months.Changes of visual acuity,the depth of anterior chamber,intraocular pressure and corneal endothelial cell counting before and after operation as well as the adverse reactions were observed and compared.Results Compared with visual acuity before treatment,the visual acuity of the patients in both groups improved significantly after treatment(P <0.05).The anterior chamber depth grades of patients in both groups were significantly higher than those before treat-ment (P <0.05),and after treatment,the anterior chamber depth grade of the patients in the observation group was significantly better than that in the control group (P <0.05).There was no significant difference of intraocular pressure before and after the treatment in both groups (P>0.05).The corneal endothelial cell density of the patients in the observation group decreased (P >0.05),while that in the control group decreased significantly (P <0.05).The corneal en-dothelial cell density of the patients in the observation group after the corneal endothelium was significantly higher than that in the control group (P <0.05).The incidence rates of adverse re-action in the two groups were 21.33%(16 /75)and 21.31%(13 /61)respectively,and the symp-tom were controlled and cured after the symptomatic treatment.Conclusion Application of man-ual nuclear delivery after ultrasonic chopping nucleus through small scleral tunnel incision for the patients with hard nucleus cataract after glaucoma surgery can effectively improve the visual acuity and anterior chamber depth of the patients.It is safe and better than ultrasonic emulsification nu-cleus surgery in the aspects of improving anterior chamber depth and reducing the injury to corneal cells.It is worthy of clinical application.