白内障超声乳化吸除术中混合超声模式的应用研究

发布时间：2018-01-23 20:54

  本文关键词： 扭动模式 白内障 超声乳化 角膜内皮细胞　出处：《山东大学》2010年硕士论文　论文类型：学位论文

【摘要】： 【目的】白内障是世界范围内主要的致盲眼病,到目前为止,白内障手术摘除合并人工晶体植入仍是公认的白内障治疗最有效的手段。白内障手术日趋完美,已经成为屈光意义的手术,白内障超声乳化手术已经成为大多数眼科医生治疗白内障的首选术式。然而超声乳化手术中超声波会对眼组织产生一定损伤,因此尽可能减少超声能量对眼组织的损伤一直是眼科医生关注的课题。一种新型的超声乳化模式——扭动模式,可以提高白内障超声乳化的效率,减轻角膜内皮损伤。本研究目的在于探讨混合超声动力模式(扭动模式联合往复模式)应用于白内障超声乳化吸除术的安全性及有效性。 【方法】本研究为前瞻性研究。病例均来自山东大学附属济南市中心医院,术前诊断年龄相关性白内障,共266例(291眼)。术前按照登记顺序随机分为3组,传统组(往复超声模式)97眼,混合组(扭动+往复模式)98眼,扭动组(单纯扭动模式)96眼。术前排除患有其它眼科疾病以及影响视力的疾病。在2.2mm微切口下分别使用传统模式、混合模式、扭动模式乳化吸除晶状体核组织。记录并比较术中所使用的超声时间(UST)、超声能量(CDE)、术后1d、7d角膜水肿程度、最佳矫正视力,术后7d、1个月角膜内皮细胞数和角膜内皮细胞丢失率。 【结果】UST比较：传统组Ⅱ级核17.80±5.55秒,Ⅲ级核30.54±5.23秒,Ⅳ-Ⅴ级核52.01±15.43秒；混合组Ⅱ级核14.22±3.99秒,Ⅲ级核23.46±6.00秒,Ⅳ-Ⅴ级核38.93±12.09秒；扭动组Ⅱ级核13.75±6.03秒；Ⅲ级核25.65±5.42秒,Ⅳ-Ⅴ级核39.62±11.46秒,3组之间比较差异有统计学意义,P0.05。CDE比较：传统组Ⅱ级核5.84%±2.23%,Ⅲ级核10.66%±3.06%,Ⅳ-Ⅴ级核18.79%±5.46%；混合组Ⅱ级核3.88%±1.74%,Ⅲ级核8.47%±1.79%,Ⅳ-Ⅴ级核14.82%±5.57%；扭动组Ⅱ级核3.65%±1.72%,Ⅲ级核8.23%±3.04%,Ⅳ-Ⅴ级核14.85%±4.33%,3组之间比较差异有统计学意义,P0.05。UST和CDE在Ⅱ,Ⅲ及Ⅳ-Ⅴ级硬度核中,传统组均大于混合组和扭动组,且随核硬度增加而增加,差异有统计学意义；扭动组与混合组差异无统计学意义。术后角膜水肿程度：术后1天及7天,混合模式组与扭动模式组均轻于传统模式组,差异具有统计学意义,P0.05,术后1月3组均无角膜水肿。术后最佳矫正视力(BCVA)：术后1天及7天,混合模式组与扭动模式组均好于传统模式组,差异具有统计学意义,P0.05,术后1月,3组比较差异无统计学意义,P0.05。 【结论】混合超声模式与扭动模式相仿,可减少术中超声能量和超声时间,增加核的追随性,减低排斥力,提高乳化效率。明显减轻患者角膜内皮细胞的损伤,角膜恢复快于传统模式,短时间内即可获得良好的视觉效果,较传统超声模式更为安全有效。在硬核处理中,混合模式对减少超乳管道阻塞和视野雾化程度方面都优于单纯使用扭动模式,为硬核白内障提供了更为有效安全的超声乳化动力模式。
[Abstract]:[objective] Cataract is the leading cause of blindness in the world, so far, cataract surgery with intraocular lens implantation is still recognized as the most effective means of cataract treatment, cataract surgery is becoming more and more perfect. Phacoemulsification has become the first choice for most ophthalmologists in the treatment of cataract. However, ultrasound can cause some damage to ocular tissue in phacoemulsification. Therefore, minimizing the damage of ultrasonic energy to ocular tissue has been a focus of ophthalmologists. A new mode of phacoemulsification, torsion mode, can improve the efficiency of phacoemulsification of cataract. The purpose of this study was to investigate the safety and efficacy of hybrid ultrasound dynamic mode (torsion mode combined with reciprocating mode) in phacoemulsification of cataract. [methods] this study was a prospective study. All the patients were from Jinan Central Hospital affiliated to Shandong University and were diagnosed with age-related cataract before operation. A total of 266 cases (291 eyes) were randomly divided into three groups according to the order of registration before operation: the traditional group (97 eyes) and the mixed group (98 eyes). Torsion group (96 eyes with simple torsion mode. Other ophthalmic diseases and diseases affecting visual acuity were excluded before operation. Traditional mode and mixed mode were used under 2.2 mm microincision. Phacoemulsification in torsion mode was used to remove the nucleus of lens. The time of ultrasound used during operation was recorded and compared. The ultrasonic energy and CDEI were recorded and compared. The degree of corneal edema was 7 days after operation, and the best corrected visual acuity was obtained. The number of corneal endothelial cells and the rate of corneal endothelial cell loss were 1 month after operation. [results] UST comparison: in the traditional group, the nucleus of grade 鈪，

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