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目的 探讨以爆破结合高真空模式行超声乳化白内障吸除术的效果。方法 将晶状体核硬度 >Ⅲ级的白内障患者 819例 (95 4只眼 )随机分为连续组、脉冲组及爆破组行颞侧透明角膜隧道切口超声乳化白内障吸除术。术中设定负压连续组和脉冲组为 16 0mmHg(1mmHg =0 133kPa) ,爆破组为 2 5 0～ 30 0mmHg;最大能量均为 6 0 %。记录 3组患者术中实际使用的超声能量和时间、视力及角膜内皮细胞密度 ,并观察手术并发症的发生情况。结果 连续组、脉冲组及爆破组术中实际使用的超声能量分别为 2 5 36 %± 6 6 5 %、19 5 4 %± 3 5 0 %及 6 2 7%± 1 2 7% ;超声时间分别为 (2 2 2± 30 )s、(186± 4 1)s及 (36± 6 )s;比较 3组所用超声能量和时间 ,差异均有非常显著意义 (P =0 0 0 5 ,0 0 0 0 1)。3组患者术后视力均有提高 ,连续组与脉冲组比较 ,差异无显著意义 (P =0 0 6 2 ) ;与爆破组比较 ,差异有显著意义 (P =0 0 0 2 )。术后爆破组角膜内皮细胞丢失率明显低于连续组和脉冲组 (P =0 0 0 5 ,0 0 0 1)。连续组术后角膜水肿 (+++)者多于脉冲组和爆破组。结论 应用爆破结合高真空模式行超声乳化白内障吸除术 ,可明显减少超声能量和时间 ,降低角膜内皮细胞丢失率 ,减轻术后早期角膜水肿 ,值得推广使用。
Objective To investigate the effect of phacoemulsification with high-vacuum mode and burst-phacoemulsification. Methods 819 cases (954 eyes) with cataract> Ⅲ grade of nucleus of lens nucleus were randomly divided into continuous group, phacoemulsification cataract surgery with temporal clear corneal tunnel incision in pulse group and burst group. Intraoperative set negative pressure continuous group and pulse group 16 0mmHg (1mmHg = 0 133kPa), burst group 250 ~ 30 0mmHg; the maximum energy is 60%. The actual use of ultrasound energy and time, visual acuity and corneal endothelial cell density in the three groups were recorded and the incidence of surgical complications was observed. Results The actual ultrasonic energy in continuous group, pulse group and burst group were respectively 2 36% ± 6 65%, 19 5 4% ± 350% and 6 2 7% ± 1 2 7%. Ultrasound time (22 ± 30) s, (186 ± 4 1) s and (36 ± 6) s, respectively. There was a significant difference in the energy and time of ultrasound between the three groups (P = 0 0 0 5, 0 0 0 0 1). The postoperative visual acuity increased in all three groups. There was no significant difference between continuous group and pulse group (P = 0 062). The difference was significant (P = 0.00002). The loss rate of corneal endothelial cells in postoperative burst group was significantly lower than that in continuous group and pulse group (P = 0 0 0 5, 0 0 0 1). Corneal edema (+++) was more in the continuous group than in the pulse group and the burst group. Conclusion Blasting combined with high-vacuum phacoemulsification cataract surgery can significantly reduce the ultrasonic energy and time, reduce the rate of loss of corneal endothelial cells and reduce postoperative corneal edema, which is worth promoting the use of.