摘要
目的对比不同切口大小超声乳化术联合玻璃体切割术治疗老年性白内障合并黄斑病变的临床效果。方法选择2016年1—10月就诊的60例（60只眼）老年性白内障合并黄斑病变患者，按照随机数字表法分为微小切口组和常规切口组，每组30例（30只眼）。微小切口组接受1.8 mm微小切口白内障超声乳化术联合23G玻璃体切割术，常规切口组接受2.8 mm切口白内障超声乳化术联合23G玻璃体切割术。对比两组术中情况，术后1 d、1个月和6个月并发症发生情况，随访术后1、6个月眼内压（IOP）、最佳矫正视力（BCVA）、术源性散光值（SIA）、干眼症状问卷（Sx）、泪膜破裂时间（tBUT）、基础泪液分泌试验（ST）-Ⅱ。结果两组术中操作情况相似，两组手术时间和术中并发症发生率比较差异无统计学意义（P〉0.05）。术后1 d、1个月和6个月微小切口组和常规切口组IOP和术后并发症发生率比较差异均无统计学意义（P〉0.05）。术后1个月，微小切口组和常规切口组BCVA比较差异无统计学意义（P〉0.05），但是微小切口组SIA低于常规切口组（0.4 ± 0.2比0.6 ± 0.3，t = 3.038，P = 0.004），Sx低于常规切口组[（1.2 ± 0.8）分比（1.8 ± 1.1）分，t = 2.416，P = 0.019]，tBUT高于常规切口组[（5.2 ± 1.6）s比（3.8 ± 1.3）s，t = 3.454，P = 0.001），ST-Ⅱ高于常规切口组[（4.7 ± 2.1）mm比（3.5 ± 1.8）mm，t = 2.376，P = 0.021）]，差异均有统计学意义（P〈0.05）；术后6个月，两组BCVA、SIA、Sx、tBUT、ST-Ⅱ比较差异无统计学意义（P〉0.05）。结论不同切口大小的超声乳化术联合玻璃体切割术治疗老年性白内障合并黄斑病变同样安全、有效。尽管术后远期效果相当，但是微小切口术后恢复更快，有助于早期改善术源性散光和干眼。
ObjectiveTo compare the clinical efficacy of different sized incisions for phacoemulsification combined with vitrectomy in the treatment of age-related cataract associated with maculopathy.MethodsFrom January 2016 to October 2016, a total of 60 eyes of 60 senile cataract patients with maculopathy were prospectively divided into the micro incision group and the standard incision group according the random number table, with 30 cases in each group. The micro incision group received a 1.8 mm micro incision for phacoemulsification combined with 23G vitrectomy and the standard incision group underwent a 2.8 mm incision for phacoemulsification combined with 23G vitrectomy. The intraoperative conditions and the postoperative complications of the two groups at 1 d, 1 and 6 months after surgery were compared. The intraocular pressure （IOP）, best corrected visual acuity （BCVA）, surgically induced astigmatism （SIA）, dry eye symptoms （Sx）, break-up time （tBUT）, schirmer test （ST）-Ⅱ were respectively measured at 1 and 6 months after surgery.ResultsThe operation procedures were similar in two groups, and there were no significant differences in the operative time and the incidence of intraoperative complications （P〉0.05）. There were no significant differences in IOP and the incidence of postoperative complications between two groups at 1 d, 1 and 6 months after surgery （P〉0.05）. At the time point of 1 month after operation, there was no significant difference in BCVA between two groups,but the level of SIA in micro incision group was lower： 0.4 ± 0.2 vs. 0.6 ± 0.3, t = 3.038, P = 0.004; the level of Sx micro incision group was lower： （1.2 ± 0.8）score vs. （1.8 ± 1.1） scores, t = 2.416, P = 0.019; the level of tBUT was higher： （5.2 ± 1.6） s vs. （3.8 ± 1.3） s, t = 3.454, P = 0.001; the level of ST-Ⅱ was higher： （4.7 ± 2.1） mm vs. （3.5 ± 1.8）, t = 2.376, P = 0.021; there were significant differences. At 6 months after operation, there were no significant differences in the indexes of BCVA, SIA, Sx, tBUT and ST-Ⅱbetween two groups （P〉0.05）.ConclusionsThe different sized incisions for phacoemulsification combined with vitrectomy in the treatment of senile cataract associated with maculopathy are similarly safe and effective. However, the micro incision surgery can improve the surgically-induced astigmatism and dry eye in the early stage, with a shorter postoperative recovery time.
作者
边建军
郭陈煜
周超
Bian Jianjun;Guo Chenyu;Zhou Chao.(Department of Ophthalmology, Zhuji Central Hospital, Zhejiang Zhuji 311800, China)
出处
《中国医师进修杂志》
2018年第2期158-162,共5页
Chinese Journal of Postgraduates of Medicine
基金
绍兴市科技计划项目（2014870077）
关键词
白内障
超声乳化术
玻璃体切割术
术源性散光
干眼
比较研究
Cataract
Phacoemulsification
Vitrectomy
Surgically-induced astigmatism
Dry eye
Comparative study
