摘要
目的比较高频脉冲能量模式与扭动能量模式在不同核硬度的白内障超声乳化吸除术中的应用。方法老年性白内障患者125例（133只眼），晶状体核硬度Ⅱ级34只眼，Ⅲ级48只眼，Ⅳ级51只眼（LOCSII标准分级）。按核级随机分为2组，分别采用高频脉冲、扭动能量模式行超声乳化自内障吸除联合后房型人工晶状体植入术，观察术中实际等效超声能量（totalequivalentpower，TEP），有效超声时间（effectivephacotime，EPT），累计释放能量（cumulativedissipatedenergy，CDE）；比较术后角膜内皮计数，角膜厚度，角膜水肿和前节反应状态。结果Ⅱ级核处理：高频脉冲组EPT和CDE显著高于扭动组（P〈0．05），其余各参数无显著差异。Ⅲ级核处理：高频脉冲组与扭动组EPT无显著差异，高频脉冲组CDE显著低于扭动组（13．38±2．85）VS（29．66±6．79），差异有统计学意义（P〈0．05）。Ⅳ级核处理：高频脉冲组与扭动组EPT无显著差异，高频脉冲组CDE显著低于扭动组（23．26±10．76）svs（34．23±15．99）s，差异有统计学意义（P〈0．05）。高频脉冲能量在处理Ⅱ级和Ⅲ级核中，TEP、EPT、CDE无显著差异，扭动能量在处理Ⅲ级核，TEP、EPT、CDE均显著高于Ⅱ级核处理。两组患者术后1天及1周的角膜内皮丢失率和角膜水肿率差异无统计学意义，但术后1天，高频脉冲组的角膜厚度增加率显著低于扭动组（11．57±9．37）％VS（19．02±10．32）％，差异有统计学意义（P〈0．05）。结论两种能量模式均能安全有效地处理各类硬度的晶体核。扭动能量处理软核效率高，具有超声时间短，累积释放能量低的特点。高频脉冲能量释放稳定，尤其在硬核中具有累积释放能量低，角膜内皮损伤小的优势。硬核、高龄或角膜内皮功能相对低下的患者选择高频脉冲模式可以增加手术安全性、提高早期康复满意度。
Objective To evaluate the efficacy and safety of phacoemulsification of different nucleus density using torsional modality and conventional hyper-pulse mode. Methods A total of 133 eyes （125 patients） of different nucleus density level （LOCS II criteria grade II 34 eyes, grade III 48 eyes, grade IV 51 eyes） were randomly assigned into 2 groups, torsional group （Tor group） and conventional ultrasound hyper-pulse motion group （HP group）. All surgeries were performed by a sin- gle experienced surgeon. Intraoperative parameters were TEP （Total Equivalent Power）, EPT （Effec- tive Phaco Time） and CED （Cumulative Dissipated Energy） and surgical complications. Postoperative outcomes were evaluated by visual acuity, endothelial cell counting, and average central corneal thick- ness. Results Grade II nucleus dealing： EPT and CDE of HP group was significantly higher than the Tor group （P 〈0.05）： Grade Ill and Grade IV nucleus dealing： EPT showed no difference between two groups, CDE of HP group was Significantly lower than Tor group （13.38±2.85 vs 29.66±6.79 in Grade III and 23.26±10.76 s vs 34.23±15.99s in Grand IV）. There were no difference of central corneal cell loss rate and corneal edema rate on one day or one week after surgery between two groups. The corneal thickness increase was significantly less in HP group than Tor group （11.57±9.37% vs 19.02±10.32%, P 〈0.05）. Conclusions Both torsional modality and conventional hy- per-pulse mode can deal with all kinds of nucleus effectively and safely. Torsional modality is more efficacy and quick deal in soft cataract. Hyper-pulse mode is more stable and save accumulated ener- gy in hard cataract. Hyper-pulse mode seems to be a safe and wise choice to dealing patients with hard nucleus, older age or lower corneal cell counting.
出处
《中国实用眼科杂志》
CSCD
北大核心
2012年第3期266-269,共4页
Chinese Journal of Practical Ophthalmology
关键词
超声乳化
扭动
高频脉冲
Phacoemulsification
Torsional
Hyper-pulse
