MSICS与超声乳化术治疗高度轴性近视并发白内障的临床研究

发布时间：2018-06-16 11:47

本文选题：高度近视 + 小切口手法碎核　；参考：《泸州医学院》2013年硕士论文

【摘要】：目的：探讨，观察并分析小切口白内障手法摘除(manual small incisionsurgery,MSICS)和超声乳化摘除(Ultrasonic Phacoemulsification,USPhco)联合低度数折叠式人工晶状体植入术的手术技术和临床效果，为高度轴性近视并发白内障的手术治疗提供参考。方法:收集176例(198只眼)白内障患者，眼轴≥26mm的88例（101眼），分成三组（A1组:32例33眼，B1组：31例36眼，C1组：25例32眼）；眼轴≥22mm，≤24mm的88例（97眼）分为三组（A2组：34例36眼，B2组：35例37眼，C2组：19例26眼）。A1组、A2组行小切口白内障手法碎核乳化摘除术联合折叠式人工晶状体植入；B1组、B2组行超声乳化术联合折叠式人工晶状体植入。C1组、C2组行小切口白内障手法劈核摘除术联合折叠式人工晶状体植入。分别测量患者术后1天、3天、1周、1月、3月的视力、散光、眼压、角膜内皮细胞计数、眼轴及观察术中术后并发症发生率。采用SPSS19.0统计软件包进行统计分析，独立两样本均数比较采用独立样本T检验，多个样本之间用方差分析，组间均数的两两比较采用的是LSD法。两样本相关性用Pearson相关分析。P0.05表示有统计学意义，r0.300为无相关，r=0.300～0.499为低度相关，，r=0.500～0.800为中度相关，r0.800为高度相关。结果：1、术前术后，A1组、B1组、A2组、B2组、C1组、C2组的视力差异较大，比较有统计学意义（F=5.247，P=0.003＜0.05）；术前，A1组、B1组的视力相似（P＞0.05），两组的视力均优于C1组（P＜0.05)；术后1天，A1组、B1组的视力较C1组的好（P＜0.05)；术后3天、1周、1月、3月，A1组、B1组、C1组的视力无统计学差异（P＞0.05）；术前，A2组和B2组视力无统计学差异（P＞0.05），与C2组比较，后者的视力较差（P＜0.05）；术后1天，A2组、B2组的视力较C2组的好（P＜0.05)；术后3天、1周、1月、3月，A2组、B2组、C2组的视力无统计学差异（P＞0.05）；单纯白内障组（A2组、B2组、C2组）的术前、术后视力均比高度近视组（A1组、B1组、C1组）的好，差异有显著意义（P＜0.05)；2、六组的角膜内皮细胞丢失量有显著差异性意义(P＜0.05)；A1组与B1组比较，无显著差异（P＞0.05）；A1组与A2组的差异具有统计学意义（P＜0.05），A1组与C1组比较，C1组丢失量更大（P＜0.05）；B1与B2组比较，有差异（P＜0.05），B2组较C2组丢失量少（P＜0.05）；A2组与B2组比较，无明显差异（P＞0.05）；C1组与C2组比较，差异有显著性意义（P＜0.05）3、六组眼压波动比较，各有不同（P＜0.05）；术后1天、3天、1周时，A1组的眼压波动小于B1组、C1组（P＜0.05）；术后1个月、3个月时，A1组、B1组的眼压波动差异无显著性意义（P＞0.05），A1组的眼压波动小于C1组（P＜0.05）; A1组、B1组及C1组的眼压波动均于术后1月趋于稳定（P＞0.05）；术后1天、3天、1周、1个月、3个月时，A2组、B2组的眼压波动没有显著不同（P＞0.05），A2组小于C2组的眼（P＜0.05）；A2组、B2组及C2组的眼压波动均于术后1周稳定（P＞0.05）。4、术前术后，用配对t检验，A1组、B1组、A2组、B2组、C2组的术前眼轴平均值均大于术后，但其差异无统计学意义（P＞0.05）；C1组术后眼轴平均值小于术前（P＜0.05)；术前术后的眼轴平均值差异小，无统计学意义（P＞0.05）；组间比较，A1组、B1组、C1组与A2组、B2组、C2组的眼轴测量误差有显著差异，具有统计学意义（P＜0.05)；A1组、B1组较C1组的眼轴测量误差小（P＜0.05)；A2组、B2组较C2组的眼轴测量误差小（P＜0.05)。5、预计屈光度与实际屈光度的比较用配对t检验，A1组、B1组和C1组的预计屈光度较实际屈光度大，其差异有统计学意义（P＜0.05）；A2组、B2组及C2组的预计屈光度与实际屈光度相似，无明显差异（P＞0.05）；屈光度度误差的比较用LSD法，A1组、B1组、C1组与A2组、B2组、C2组的屈光度误差有显著差异，具有统计学意义（F=16.24,P＜0.05)；A1组和B1组屈光度误差比较，无统计学意义（P＞0.05）；A1组和C1组屈光度误差不同（P＜0.05）；A2组和B2组屈光度误差比较，无统计学意义（P＞0.05）；A2组较C2组屈光度误差小（P＜0.05）。6、高度近视组（A2组、B2组及C2组）中，屈光度误差与眼轴长度、眼轴测量误差均有相关性(r＞0.300)，并且随着眼轴的增长，其相关性增大；在单纯白内障组（A2组、B2组及C2组）中，屈光度误差的绝对差值与眼轴无相关(r＜0.300)。7、A1组、B1组、A2组、B2、C1组及C2组六组比较，术前及术后的角膜散光，差异没有统计学意义（P＞0.05)；A1组的术前与术后比较，用配对t检验，术前与术后1天、术后3天、术后1月、术后3个月的差异有统计学意义(P=0.00＜0.05)，术前的散光与术后1周的散光比较，无明显差异（P=0.356＞0.05）；B1组、A2组、B2组、C1组、C2组用上述t检验，得出与A1组相似的结果：术前与术后1天、术后3天、术后1月、术后3个月的差异有统计学意义(P＜0.05)，术前的散光与术后1周的散光比较，无明显差异（P＞0.05）。A1、B1、A2、B2、C1、C2六组的术前角膜散光均以逆规性散光为主，术后1天、3天、1周时，顺规性散光比例增加1个月后逆规性散光增加，3个月后，逆规性散光所占比例超过术前。用R×C列联表资料的χ2检验，比较术前、术后的角膜散光轴向构成比，无统计学差异（P＞0.05）。8.术后1天、3天、1周、1个月、3个月，A1组、B1组、A2组、B2组、C1组、C2组的SIA，采用方差分析统计，其值无明显差异（P＞0.05）;六组的术后SIA,进行配对t检验，术后1天到术后1月的SIA有差异（P＜0.05），术后1月与术后3月的SIA相似（P＞0.05）；A1组术后SIA比较，于3个月时趋于稳定; B1组、A2组、B2组、C1组、C2组的术后SIA比较，结果同A1组及B1组。结论：1.带球结膜蒂的小切口白内障手法碎核乳化摘除术术后的视力、眼压、散光与超声乳化白内障摘除术相比并无明显差异，两者术后效果相似，但前者手术可控性好，不易出现严重并发症，对眼表损伤小。对Ⅰ～Ⅲ级核的白内障患者是较好的手术选择。2.对Ⅳ、Ⅴ级核的白内障患者，行带球结膜蒂的中小切口白内障手法劈核摘除术，其术后视力恢复可，散光小，术后并发症较少，且可规避超声乳化术的手术风险及并发症。3.对于高度近视并发性白内障并核硬的患者而言，术中操作难度大，术后角膜内皮损伤较重，且术后眼压波动大。故可建议早期手术，减少手术风险，提高术后效果。4.眼轴测量的准确与否直接影响白内障患者术后的视觉质量。只有提高眼轴长测量的准确性才能减少患者术后屈光度误差，让患者获得理想的视觉质量。
[Abstract]:Objective: To study, observation and analysis of small incision cataract extraction technique (manual small incisionsurgery, MSICS) and phacoemulsification (Ultrasonic Phacoemulsification USPhco) surgical technique and clinical effect of combined with low degree of foldable intraocular lens implantation and to provide reference for the surgical treatment of high myopia with cataract.
Methods: 176 cases (198 eyes) with cataract, 88 cases (101 eyes) of 26mm, were divided into three groups (group A1: 32 cases, 33 eyes, 31 cases 36 eyes, group C1: 25 cases 32 eyes); 88 cases (97 eyes) of ocular axis more than 22mm, < < 24mm > (A2 group: B2 group: C2 group: C2).A1 group, A2 group underwent small incision cataract manipulation nucleus. Emulsion extirpation combined with foldable intraocular lens implantation; group B1 and group B2 were treated with phacoemulsification combined with foldable intraocular lens implantation in group.C1. Group C2 had small incision cataract manipulation and foldable intraocular lens implantation. The visual acuity, astigmatism, intraocular pressure and corneal endothelium were measured at 1 days, 3 days, 1 weeks, January, and March respectively. The incidence of cell counts, ocular axis and intraoperative postoperative complications was statistically analyzed by SPSS19.0 software package. Independent samples were compared with independent sample T test, multiple samples were analyzed with variance, and the 22 comparison of intergroup average was LSD method. Two sample correlation used Pearson correlation analysis.P0.05 to show statistics. In terms of learning meaning, r0.300 is uncorrelated, r=0.300 to 0.499 is low correlation, r=0.500 to 0.800 is moderately correlated, and r0.800 is highly correlated.
Results: 1, before and after operation, the visual differences between group A1, group B1, group A2, group B2, group C1, group C2 and group C2 were significant (F=5.247, P=0.003 < 0.05); the visual acuity of group A1 and B1 group was similar (P > 0.05) before operation, and the visual acuity of group two was better than that of the C1 group (< 0.05); 1 days after the operation, the visual acuity of the group was better than that of the group (0.05); and 3 days, 1 weeks, January, 3 after the operation. There was no significant difference in visual acuity between group A1, group B1 and group C1 (P > 0.05). Before operation, there was no significant difference in visual acuity between group A2 and B2 group (P > 0.05). Compared with group C2, the visual acuity of the latter was poor (P < 0.05); the vision of the latter was better than that of the C2 group at 1 days, A2, and B2 group (0.05); the 3 days, 1 weeks, January, March, the group, and the group had no statistical difference (0). .05); the visual acuity of the simple cataract group (group A2, group B2, C2) was better than that of the high myopia group (group A1, B1, C1), and the difference was significant (P < 0.05). 2, the loss of corneal endothelium in the six groups was significantly different (P < 0.05); there was no significant difference between the A1 group and the B1 group (P > 0.05). Statistical significance (P < 0.05), compared with group C1, group A1 was more lost in C1 (P < 0.05), and there was a difference between B1 and B2 group (P < 0.05), and the loss of B2 group was less than that of C2 group (P < 0.05), and there was no significant difference between A2 group and group (0.05). At 1 days, 3 days and 1 weeks after operation, the intraocular pressure fluctuation in group A1 was less than that of group B1 and group C1 (P < 0.05). There was no significant difference in intraocular pressure fluctuation between group A1 and B1 group (P > 0.05) at 1 months and 3 months after operation (P > 0.05), and group A1 was less than C1 (P < 0.05) in A1 group (P < 0.05) in A1 group, and in B1 group and group after operation in January (0.05); postoperative 1 days postoperatively. In 3 days, 1 weeks, 1 months, 3 months, group A2 and group B2 had no significant difference in intraocular pressure (P > 0.05), group A2 was less than that in group C2 (P < 0.05); the intraocular pressure fluctuations in group A2, B2 and C2 were all stable (P > 0.05) 1 weeks after operation (P > 0.05).4. There was no statistical significance (P > 0.05), and the average value of ocular axis in group C1 was less than that before operation (P < 0.05), and the mean value of ocular axis was small and no statistical significance (P > 0.05) before and after operation; compared with group A1, B1, C1 group and A2 group, B2 group and C2 group, there were significant differences between groups (P < 0.05); A1 group was more than group. The error of ocular axis measurement was small (P < 0.05); in group A2, group B2 was smaller than that in group C2 (P < 0.05).5. Compared with actual refractive index, the predicted diopter of group A1, B1 group and C1 group was larger than actual refractive index, and the difference was statistically significant (P < 0.05). The photometric similarity was no significant difference (P > 0.05). The diopter error was compared with LSD, A1, B1, C1 and A2, B2 group and C2 group, which was statistically significant (F=16.24, P < 0.05), and there was no significant difference between A1 and B1 group (0.05). 5): the diopter error of group A2 and B2 group was not statistically significant (P > 0.05); the refractive error of group A2 was smaller than that of C2 group (P < 0.05).6. In the high myopia group (A2 group, B2 group and C2 group), the refractive error was correlated with the eye axis length and the ocular axis measurement error (r > 0.300), and the correlation increased with the increase of the ocular axis; in the simple cataract, the correlation was increased and the cataract was increased in simple cataract. In group A2, group B2 and group C2, the absolute difference of diopter error was compared with the ocular axis (r < 0.300).7, A1 group, B1 group, A2 group, B2, C1 group and C2 group. There was no statistical difference between preoperative and postoperative corneal astigmatism (P > 0.05). The preoperative and postoperative comparison, preoperative and 1 days, 3 days after operation, and January, The difference between 3 months after operation was statistically significant (P=0.00 < 0.05). There was no significant difference between preoperative astigmatism and astigmatism after 1 weeks (P=0.356 > 0.05); group B1, group A2, group B2, group C1, and group C2 obtained the similar results with the A1 group: 1 days before operation, 3 days after operation, January after operation, 3 months after operation (P < 0.05), there was no significant difference between preoperative astigmatism and astigmatism after 1 weeks (P > 0.05).A1, B1, A2, B2, C1, and C2 six, the preoperation corneal astigmatism was mainly reverse optical astigmatism, 1 days, 3 days, 1 weeks postoperatively, the proportion of paraminic astigmatism increased after 1 months, and the proportion of reverse optical astigmatism after 3 months was more than before operation. R x C contingency table was used. The X-ray 2 test was used to compare the axial component ratio of corneal astigmatism before and after operation. There was no statistical difference (P > 0.05) 1 days, 3 days, 1 weeks, 1 months, 3 months, group A1, group B1, group A2, B2, C1, C2, and there was no significant difference (P > 0.05) with variance analysis (P > 0.05); the six group after operation SIA, 1 days after operation to January after the operation. The difference in SIA (P < 0.05) was similar to that of SIA after operation in January and March after operation (P > 0.05); SIA in group A1 was more stable after 3 months, and in group B1, A2, B2, C1, C2.
Conclusion: 1. the visual acuity, intraocular pressure, astigmatism and phacoemulsification after cataract extraction and phacoemulsification are not significantly different from those of phacoemulsification. The results are similar, but the former has good controllability, no serious complications and small ocular surface injury. It is a better operation to select.2. for patients with cataract in grade IV and grade V, with small incision and small incision for cataract surgery. The postoperative visual acuity, astigmatism, and postoperative complications are less, and the risk of phacoemulsification and complications can be avoided in patients with high myopia complicated with cataract and hard nuclear. It is difficult to operate in the operation, the corneal endothelium injury is heavy after operation, and the intraocular pressure fluctuates greatly after operation. Therefore, early operation can be suggested to reduce the risk of operation and improve the accuracy of.4. eye axis measurement after operation. Poor, let the patient get the ideal visual quality.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.66

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