CAJ | 학술논문

目的对比飞秒激光超声乳化白内障吸除术与传统2.2 mm同轴微切口超声乳化白内障吸除术早期临床效果,探讨飞秒激光超声乳化白内障吸除术的有效性及安全性.方法前瞻性队列研究.选择2013年12月至2014年5月在山西省眼科医院行超声乳化白内障吸除联合人工晶状体(IOL)植入术的年龄相关性白内障患者87例(114眼),根据手术方式分为2组,飞秒激光超声乳化手术组(FLACS组)44例(60眼),2.2 mm同轴微切口超声乳化白内障吸除术组(传统组)43例(54眼).FLACS组利用LenSx飞秒设备,在前节光学相干断层扫描(OCT)的监测下行前囊膜环形切开、碎核、制作2.2 mm透明角膜切口.传统组手工制作2.2 mm透明角膜切口,连续环形撕囊.根据患者需求,选择植入非球面IOL(SN60WF)或多焦点IOL(SN6AD1),对比2种手术方式术后早期远视力、中央角膜厚度、角膜内皮细胞计数、超声能量的使用情况及术中术后并发症的差异.采用秩和检验、独立样本t检验及配对t检验进行数据分析.结果 2组术后1个月远UCVA及BCVA差异无统计学意义;FLACS组角膜内皮细胞密度丢失率低于传统组,但差异无统计学意义;FLACS组术后中央角膜厚度恢复早于传统组.FLACS组超声时间较传统组减少30％,累计释放能量较传统组减少49％,2组差异有统计学意义(t=-2.739,P＜0.01;Z=-2.979,P＜0.01).飞秒激光制作的透明角膜切口,78％可以顺利用分离器分开,13％主切口需要用角膜刀手工穿刺,7％侧切口需要角膜刀穿刺,2％发生主切口倾斜.飞秒激光进行前囊膜切开,93％顺利完成,7％发生不连续撕囊,需要手工调整,撕开部分囊膜,使之完全游离.结论飞秒激光超声乳化白内障吸除术与传统2.2 mm同轴微切口超声乳化白内障吸除术相比,其使用的超声能量大大减少,术后早期角膜组织恢复更快,手术更加安全有效.
목적 대비비초격광초성유화백내장흡제술여전통2.2 mm동축미절구초성유화백내장흡제술조기림상효과,탐토비초격광초성유화백내장흡제술적유효성급안전성.방법 전첨성대렬연구.선택2013년12월지2014년5월재산서성안과의원행초성유화백내장흡제연합인공정상체(IOL)식입술적년령상관성백내장환자87례(114안),근거수술방식분위2조,비초격광초성유화수술조(FLACS조)44례(60안),2.2 mm동축미절구초성유화백내장흡제술조(전통조)43례(54안).FLACS조이용LenSx비초설비,재전절광학상간단층소묘(OCT)적감측하행전낭막배형절개、쇄핵、제작2.2 mm투명각막절구.전통조수공제작2.2 mm투명각막절구,련속배형시낭.근거환자수구,선택식입비구면IOL(SN60WF)혹다초점IOL(SN6AD1),대비2충수술방식술후조기원시력、중앙각막후도、각막내피세포계수、초성능량적사용정황급술중술후병발증적차이.채용질화검험、독립양본t검험급배대t검험진행수거분석.결과 2조술후1개월원UCVA급BCVA차이무통계학의의;FLACS조각막내피세포밀도주실솔저우전통조,단차이무통계학의의;FLACS조술후중앙각막후도회복조우전통조.FLACS조초성시간교전통조감소30％,루계석방능량교전통조감소49％,2조차이유통계학의의(t=-2.739,P＜0.01;Z=-2.979,P＜0.01).비초격광제작적투명각막절구,78％가이순이용분리기분개,13％주절구수요용각막도수공천자,7％측절구수요각막도천자,2％발생주절구경사.비초격광진행전낭막절개,93％순리완성,7％발생불련속시낭,수요수공조정,시개부분낭막,사지완전유리.결론 비초격광초성유화백내장흡제술여전통2.2 mm동축미절구초성유화백내장흡제술상비,기사용적초성능량대대감소,술후조기각막조직회복경쾌,수술경가안전유효.
Objective To investigate the safety and efficacy of femtosecond laser-assisted cataract surgery compared to conventional cataract surgery.Methods Eighty-seven patients (114 eyes) were enrolled in this prospective cohert study between December 2013 and May 2014 in Shanxi Eye Hospital.Forty-four patients (60 eyes) underwent femtosecond laser-assisted cataract surgery.Forty-three patients (54 eyes) underwent 2.2 mm coaxial microincision cataract surgery.Femtosecond laser-assisted cataract surgery involved anterior capsulotomy, corneal incision and lens fragmentation based on optical coherence tomography-guided treatment mapping.An aspheric intraocular lens (SN60WF) or a multifocal intraocular lens (SN6AD1) was implanted based on the patient's preference.Intraoperative complication rates and phaco energy parameters were recorded.Visual acuity, central corneal thickness and corneal endothelial cell loss were analyzed and the measurements were compared between the two groups.Results There were no statistically significant differences in visual acuity and best correctedvisual acuity (BCVA).The reduction in the mean number of endothelial cells was lower in the femtosecond laser-assisted cataract surgery group, but the difference was not significant.U/S total time was reduced to 30％ compared to the conventional cataract surgery group (t=-2.739, P＜0.01).Cumulative dissipated energy (CDE) was reduced 49％ (Z=-2.979, P＜0.01).In the femtosecond laser-assisted cataract surgery group, an incision was easily opened in 78％;incisions for the remaining patients were more difficult to perform.93％ of the capsule buttons were free floating and 7％ were incomplete and a manual capsulorrhexis was required to complete the capsulotomy.Conclusion Femtosecond laser capsulotomy and lens fragmentation significantly reduce ultrasound use compared to conventional surgery.The new surgery appears to be safer and more efficient than conventional cataract surgery in the short term postoperatively.