小瞳孔白内障超声乳化术中内置式虹膜扩张器的应用

发布时间：2018-06-27 07:27

本文选题：白内障 + 小瞳孔　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:与非瞳孔扩张法相比,OASIS内置式虹膜扩张器在小瞳孔白内障超声乳化术中的总体手术时间、有效超乳时间和术后早期房水闪光情况、角膜内皮细胞计数情况、角膜水肿程度、最佳矫正视力,以及手术难度评价和患者术后满意度等方面对比分析,从而评价新型内置式虹膜扩张器的应用效果。方法:选择2014年12月-2015年12月于我院住院行手术治疗的小瞳孔白内障患者(药物不能散大瞳孔)32例(32眼)设为OASIS组,选择回顾性小瞳孔白内障临床病例(未借助扩瞳器械)32例(32眼)设为传统手术组。OASIS组植入OASIS内置式虹膜扩张器扩大瞳孔行常规晶状体超声乳化摘除联合人工晶体植入术;传统手术组未做任何形式的瞳孔扩张,直接行小直径环形撕囊及后续操作。记录两组总体手术时间,有效超乳时间,并于术后30天内随访比较两组术后房水闪光情况、角膜水肿程度和角膜内皮细胞计数情况、术后早期最佳矫正视力、分析手术难度和患者术后满意度情况。结果:II级核白内障两组总体手术时间比较差异无统计意义(P=0.463),在III、IV级核白内障总体手术时间中OASIS组均少于传统手术组,差异有统计学意(P=0.004,0.001)。II、III、IV级核白内障有效超声乳化时间OASIS组均少于传统手术组,差异有统计学意义(P=0.003,P0.001,P0.001)。两组患者术后1d房水闪光差异有统计学意义(P=0.018),术后1周两组房水闪光均消失。两组患者术后1d及7d角膜水肿情况差异有统计学意义(P=0.001,0.012)。术后7d及30d角膜内皮细胞计数差异有统计学意义(P=0.001,0.04)。两组患者术后1d最佳矫正视力差异有统计学意义(P=0.001),术后7d,30d差异无统计学意义(P=0.053,1.000)。两组手术难度比较差异有统计学意义(P0.001)。术后满意度比较两组差异有统计学意义(P=0.047)。结论:OASIS新型内置式虹膜扩张器较非瞳孔扩张法在小瞳孔白内障超声乳化术中降低手术难度,缩短超乳时间,组织损伤小,患者满意度高,是一种安全有效的扩瞳装置,值得临床推广应用。
[Abstract]:Objective: compared with non-pupil dilatation, the total operative time, effective superemulsion time, early aqueous humor flash and corneal endothelial cell count in phacoemulsification of small pupillary cataract with Oasis built-in iris dilator were studied. The degree of corneal edema, the best corrected visual acuity, the evaluation of surgical difficulty and the patients' satisfaction after operation were compared and analyzed, so as to evaluate the application effect of the new built in iris dilator. Methods: from December 2014 to December 2015, 32 patients (32 eyes) with small pupillary cataract who underwent surgical treatment in our hospital from December 2014 to December 2015 were selected as Oasis group. 32 cases (32 eyes) of small pupillary cataract (without pupil dilatation) were selected as traditional operation group. Oasis group was implanted with Oasis inbuilt iris dilator to dilate pupil, and routine phacoemulsification combined with intraocular lens implantation was performed. The traditional operation group did not do any form of pupil dilatation, directly small diameter circular capsulorhexis and follow-up operation. The total operative time and effective suckling time were recorded in both groups. The flash of aqueous humor, the degree of corneal edema and the count of corneal endothelial cells were compared between the two groups within 30 days after operation, and the best corrected visual acuity was obtained in the early postoperative period. The difficulty of operation and patients' satisfaction after operation were analyzed. Results there was no significant difference in the total operative time between the two groups (P0. 463). Oasis group was less than the traditional operation group in the total operation time of grade IV nuclear cataract. The effective phacoemulsification time in the Oasis group was significantly shorter than that in the traditional operation group (P0. 003 + P0.001 / P0.001). There was a significant difference in the flash of aqueous humor between the two groups on the 1st day after operation (P0. 018), and the flash of aqueous humor disappeared 1 week after operation in both groups. There was a significant difference in corneal edema between the two groups on day 1 and day 7 after operation (P < 0.001 or 0.012). There was significant difference in corneal endothelial cell count between 7 days and 30 days after operation (P < 0.001 / 0. 04). There was significant difference in the best corrected visual acuity between the two groups on the 1st day after operation (P0. 001), but there was no significant difference between the two groups on the 7th day after operation (P0. 053 / 1. 000). There was significant difference in the difficulty of operation between the two groups (P 0.001). There was a significant difference in postoperative satisfaction between the two groups (P0. 047). Conclusion compared with the non-pupillary dilatation, the new type of iridodilator is a safe and effective pupil dilatation device, which can reduce the difficulty of operation, shorten the time of superemulsion, reduce the tissue damage and increase the satisfaction of patients with the phacoemulsification of small pupillary cataract. It is worth popularizing and applying in clinic.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.66

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