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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:

39卷

期数:

2019年1期

页码:

068-71

栏目:

应用研究

出版日期:

2019-01-05

文章信息/Info

Title:

Effects of gravity fluid flow system and active control fluid flow system on cumulative dissipated energy in post-phacoemulsification vision recovery and corneal endothelium

作者:

王海伟; 岳岩坤

100038　北京市，首都医科大学附属复兴医院眼科

Author(s):

WANG Hai-Wei; YUE Yan-Kun

Department of Ophthalmology，Fuxing Hospital，Capital Medical University，Beijing 100038，China

关键词:

主动液流; 重力液流; 累积释放能量; 角膜内皮; 白内障超声乳化

Keywords:

active fluidflow; gravity fluid flow; cumulative dissipated energy; corneal endothelium; phacoemulsification

分类号:

R776.1

DOI:

10.13389/j.cnki.rao.2019.0015

文献标志码:

A

摘要:

目的　对比重力液流系统和主动控制液流系统对白内障超声乳化手术中累积释放能量（cumulative dissipated energy，CDE）及术后视力恢复、角膜内皮参数的影响。方法　选取2017年10月至12月于首都医科大学附属复兴医院眼科行白内障手术患者96例（96眼）。所有患者均患有年龄相关性白内障，LOCS III晶状体核透光性和晶状体核颜色评分为4.0~6.9分。依照液流系统选择情况分为：重力组（48例48眼），使用Centurion重力液流系统；主控组（48例48眼），使用Centurion主动控制液流系统。术中记录每例患者CDE；术后1周、1个月、3个月复诊，行眼科常规检查，包括视力、眼压、裂隙灯、眼底镜等；所有患者术前行非接触角膜内皮镜检查，记录角膜内皮细胞密度（endothelial cell density，ECD）、内皮细胞变异系数（coefficient of variance，CV）、角膜六角形内皮细胞比率（percentage of hexagonal endothelial cells，6A）及中央角膜厚度（central corneal thickness，CCT）。每次复查均行角膜内皮镜检查获取ECD、内皮细胞CV、6A、CCT等数据。结果　术前重力组和主控组患者的年龄、性别、晶状体核透光性、晶状体核颜色评分比较，差异均无统计学意义（均为P＞0.05）。术前两组患者最佳矫正视力比较，差异无统计学意义（P＞0.05），术后1周主控组患者最佳矫正视力较重力组明显提高，差异有统计学意义（P＜0.05），术后1个月和3个月两组间最佳矫正视力差异均无统计学意义（均为P＞0.05）。重力组与主控组术中CDE差异无统计学意义（P＞0.05）。总体CDE均与术前晶状体核分级呈正相关性（晶状体核透光性：r=0.703，P=0.001；晶状体核颜色评分：r=0.804，P=0.000），术前晶状体核分级越高术中CDE越大。重力组和主控组术前ECD、内皮细胞CV、6A、CCT相似，差异均无统计学意义（均为 P＞0.05）。术后1周ECD、内皮细胞CV、6A比较，两组间差异均无统计学意义（均为P＞0.05），但重力组CCT［（570.60±34.99）μm］明显大于主控组［（554.67±30.71）μm］，差异有统计学意义（P＜0.05）；术后1个月和3个月两组ECD、内皮细胞CV、6A、CCT比较，差异均无统计学意义（均为P＞0.05）。结论　Centurion超声乳化手术系统中重力液流系统及主动控制液流系统对术中CDE及角膜内皮的影响相似，主动控制液流系统能够更有效地减轻术后角膜水肿，使患者在术后早期视力恢复更迅速。

Abstract:

Objective　To compare the effect of gravity fluid flow system and active control fluid flow system in phacoemulsification by comparing the cumulative dissipated energy （CDE） during operation，postoperative visual acuity recovery and corneal endothelial parameters.Methods　Ninety-six patients （96 eyes） with cataract underwent cataract surgery from October to December 2017 in the Department of Ophthalmology，Fuxing Hospital of Capital Medical University were included.All patients suffered from age-related cataract.The LOCS III lens nuclear opacity （NO） and nuclear color （NC） score ranged from 4.0 to 6.9.According to the selection of fluid flow system，the patients were divided into gravity group （48 patients，48 eyes），using Centurion gravity fluid flow system，and active control group （48 patients，48 eyes），using Centurion active control fluid flow system.CDE of each patient was recorded during the operation，and routine ophthalmological examinations including vision，intraocular pressure，slit lamp and fundus were performed 1 week，1 month and 3 months after the operation.Non-contact corneal endothelioscopy was performed before the operation to record corneal endothelial cell density （ECD），endothelial cells coefficient of variance （CV），percentage of hexagonal endothelial cells （6A） and central corneal thickness （CCT）.The ECD，CV，6A，CCT and other data were obtained in each follow-up.Results　There was no significant difference in age，sex，NO and NC score between gravity group and active control group before surgery （all P>0.05）.There was no significant difference in the best corrected visual acuity between the two groups before surgery （P>0.05）.The best corrected visual acuity of the active control group was significantly higher than that of the gravity group one week after the surgery （P<0.05）.The best corrected visual acuity was similar between the two groups one month and three months after operation （both P>0.05）.There was not statistically significant difference in CDE between the active control group and the gravity group （P>0.05）.The CDE was positively correlated with preoperative classification of lens nuclear（NO：r=0.703，P=0.001；NC：r=0.804，P=0.000），the higher the preoperative lens nuclear score，the greater the intraoperative CDE.The ECD，CV，6A，CCT were similar between the two groups before the surgery （all P>0.05）.Corneal central thickness in the gravity group ［（570.60±34.99）μm］ was significantly greater than that in the active control group［（554.67±30.71）μm］ one week after the surgery （P<0.05），and there were no significant differences in other corneal parameters include ECD，CV，6A，CCT at different time after the surgery （all P>0.05）.Conclusion　The effects of gravity fluid flow and active control fluid flow system on CDE and corneal endothelium are similar in Centurion phacoemulsification.Active control fluid flow system could alleviate postoperative corneal edema more effectively，so that visual recovery faster in the early postoperative.

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更新日期/Last Update: 2019-01-04