目的 对比研究膨胀期老年人白内障采用超声乳化和小切口囊外摘除手术方式的安全性和手术效果. 方法 前瞻性随机对照研究,将符合入组标准的200例(200只眼)膨胀期白内障患者随机分成两组,108例(108只眼)使用白内障超声乳化技术(phacoemulsification,PE),92例(92只眼)采用小切口囊外摘除术(extracapsular cataract extraction,ECCE).患眼均选择上方巩膜隧道切口,胎盘蓝囊膜染色后,PE组行最小化连续环形撕囊(continuous curvilinear capsulorhexis,CCC),设计撕囊直径约4 mm.常规超声乳化、置入人工晶状体后再扩大撕囊直径至6 mm;ECCE组行常规连续环形撕囊或开罐式截囊,设计直径7～8 mm.水化晶状体核后,扩大巩膜隧道切口至6～7 mm,圈套器娩出晶状体核.对两组患者的术中、术后并发症及术后效果进行统计分析. 结果 两组患者年龄,性别和核硬度比较差异无统计学意义(均P＞0.05).术前2组患者最佳矫正视力均≤0.05(100％),术后3 dPE组105只眼最佳矫正视力≥0.05(97.2％,105/108),82只眼≥0.3(75.9％,82/108).ECCE组89只眼最佳矫正视力≥0.05 (96.7％,89/92),72只眼≥0.3 (78.3％,72/92).两组的脱盲率、脱残率比较差异无统计学意义(x2值分别为0.04、0.15,P=0.84,P=0.70).PE组连续环形撕囊的失败率(8.3％,9/108),囊膜向周边放射状裂开率(20.4％,22/108)和后囊膜破裂、玻璃体丢失(0.9％,1/108)、虹膜脱出(0％,0/108)等术中并发症发生率低于小切口ECCE组(分别为20.7％,19/92; 39.1％,36/92; 7.6％,7/92;15.2％,14/92),差异均有统计学意义(P=0.01,P=0.00,P=0.02,P＜0.001).仅ECCE组出现术后虹膜脱出、瞳孔变形等并发症. 结论 采用小切口、小的环形撕囊、超声乳化术式,对于膨胀期白内障可以获得良好的手术效果,术中术后并发症少于ECCE的患者.
目的 對比研究膨脹期老年人白內障採用超聲乳化和小切口囊外摘除手術方式的安全性和手術效果. 方法 前瞻性隨機對照研究,將符閤入組標準的200例(200隻眼)膨脹期白內障患者隨機分成兩組,108例(108隻眼)使用白內障超聲乳化技術(phacoemulsification,PE),92例(92隻眼)採用小切口囊外摘除術(extracapsular cataract extraction,ECCE).患眼均選擇上方鞏膜隧道切口,胎盤藍囊膜染色後,PE組行最小化連續環形撕囊(continuous curvilinear capsulorhexis,CCC),設計撕囊直徑約4 mm.常規超聲乳化、置入人工晶狀體後再擴大撕囊直徑至6 mm;ECCE組行常規連續環形撕囊或開罐式截囊,設計直徑7～8 mm.水化晶狀體覈後,擴大鞏膜隧道切口至6～7 mm,圈套器娩齣晶狀體覈.對兩組患者的術中、術後併髮癥及術後效果進行統計分析. 結果 兩組患者年齡,性彆和覈硬度比較差異無統計學意義(均P＞0.05).術前2組患者最佳矯正視力均≤0.05(100％),術後3 dPE組105隻眼最佳矯正視力≥0.05(97.2％,105/108),82隻眼≥0.3(75.9％,82/108).ECCE組89隻眼最佳矯正視力≥0.05 (96.7％,89/92),72隻眼≥0.3 (78.3％,72/92).兩組的脫盲率、脫殘率比較差異無統計學意義(x2值分彆為0.04、0.15,P=0.84,P=0.70).PE組連續環形撕囊的失敗率(8.3％,9/108),囊膜嚮週邊放射狀裂開率(20.4％,22/108)和後囊膜破裂、玻璃體丟失(0.9％,1/108)、虹膜脫齣(0％,0/108)等術中併髮癥髮生率低于小切口ECCE組(分彆為20.7％,19/92; 39.1％,36/92; 7.6％,7/92;15.2％,14/92),差異均有統計學意義(P=0.01,P=0.00,P=0.02,P＜0.001).僅ECCE組齣現術後虹膜脫齣、瞳孔變形等併髮癥. 結論 採用小切口、小的環形撕囊、超聲乳化術式,對于膨脹期白內障可以穫得良好的手術效果,術中術後併髮癥少于ECCE的患者.
목적 대비연구팽창기노년인백내장채용초성유화화소절구낭외적제수술방식적안전성화수술효과. 방법 전첨성수궤대조연구,장부합입조표준적200례(200지안)팽창기백내장환자수궤분성량조,108례(108지안)사용백내장초성유화기술(phacoemulsification,PE),92례(92지안)채용소절구낭외적제술(extracapsular cataract extraction,ECCE).환안균선택상방공막수도절구,태반람낭막염색후,PE조행최소화련속배형시낭(continuous curvilinear capsulorhexis,CCC),설계시낭직경약4 mm.상규초성유화、치입인공정상체후재확대시낭직경지6 mm;ECCE조행상규련속배형시낭혹개관식절낭,설계직경7～8 mm.수화정상체핵후,확대공막수도절구지6～7 mm,권투기면출정상체핵.대량조환자적술중、술후병발증급술후효과진행통계분석. 결과 량조환자년령,성별화핵경도비교차이무통계학의의(균P＞0.05).술전2조환자최가교정시력균≤0.05(100％),술후3 dPE조105지안최가교정시력≥0.05(97.2％,105/108),82지안≥0.3(75.9％,82/108).ECCE조89지안최가교정시력≥0.05 (96.7％,89/92),72지안≥0.3 (78.3％,72/92).량조적탈맹솔、탈잔솔비교차이무통계학의의(x2치분별위0.04、0.15,P=0.84,P=0.70).PE조련속배형시낭적실패솔(8.3％,9/108),낭막향주변방사상렬개솔(20.4％,22/108)화후낭막파렬、파리체주실(0.9％,1/108)、홍막탈출(0％,0/108)등술중병발증발생솔저우소절구ECCE조(분별위20.7％,19/92; 39.1％,36/92; 7.6％,7/92;15.2％,14/92),차이균유통계학의의(P=0.01,P=0.00,P=0.02,P＜0.001).부ECCE조출현술후홍막탈출、동공변형등병발증. 결론 채용소절구、소적배형시낭、초성유화술식,대우팽창기백내장가이획득량호적수술효과,술중술후병발증소우ECCE적환자.
Objective To compare the safety and effect of the phacoemulsification (PHACO) versus extracapsular cataract extraction (ECCE) in patients with intumescent senile cataract.Methods 200 eyes from patients with intumescent cataract were included and randomly divided into 2 groups:PE group (108 eyes,received PHACO) and ECCE group (92 eyes,received small incision ECCE) respectively.Superior quadrant sclera tunnel incisions were made with stabs of 2.8 mm diameters.Trypan-blue was used to show the anterior lens capsular membrane.In the PHACO group,a 4 mm diameters continuous curvilinear capsulorhexis (CCC) was made,which was enlarged to 6-7 mm after the intraocular lenses (IOL) implantation.For the ECCE group,a 8 mm-diameter CCC was made.Then the lens nucleus was either phacoemulsificated or delivered and IOL was implanted.The complications during and after surgery and the visual outcomes were recorded and statistically analyzed by SPSS 13.0 software.Results Age,sex and the hardness of the nucleus were comparable between the two groups.The best corrected vision acuity (BCVA) was 0.05 and worse in all patients before surgery.While 3 days after operation,in PE group,105 eyes (97.2％,105/108) gained postoperative vision 0.05 and better,and 82 of them were better than 0.3; in group ECCE,97.2％ (89/92) of the operated eyes gained vision 0.05 and better,72 (78.3％,72/92) eyes were better than 0.3.No statistical differences were found between the two groups in postoperative vision recovery.While,there were more failure rates of the CCC,tear of the anterior and posterior capsular,loss of the vitreous and iris injury rate in the ECCE group than in the PE group (20.7％ vs.8.3％,17.4％ vs.12.0％,7.6％ vs.0.9％,15.2％ vs.0％,P=0.01,P=0.00,P=0.02,P＜ 0.001).Prolapse of iris and discoria were found in ECCE group.Conclusions With small CCC,phacoemulsification can lead to better surgical outcomes than small incision ECCE procedures,and the operative and post-operative complications are less in PE group than in ECCE group.
