标题：前房维持器下爆破与连续模式硬核白内障超声乳化术对角膜内皮细胞的影响

      作者：陈光胜，王冬梅，杜 毅，黄红波
    （柳州市眼科医院，广西 柳州 545001）

      卷次： 2013年24卷21期

      【摘要】 目的 探讨前房维持器下爆破与连续两种模式硬核白内障超声乳化术对角膜内皮细胞的影响。
方法 将63例(63眼)Ⅳ级硬核白内障患者连续随机分为两组：前房维持器下爆破模式组32例(32眼)、前房维持
器下连续模式组 31例(31眼)。比较两组术中并发症、术后非矫正远视力(Uncorrected distance visual acuity，
UCDVA)、角膜切口水肿情况、角膜内皮细胞损失率、角膜内皮六角形细胞比例，累积能量复合参数(Accumulated
energy complex parameter，AECP)等。随访1个月。结果 前房维持器下爆破模式组与前房维持器下连续模式对
照组比较：术后1个月UCDVA (已转换为 logMAR分值)分别为（0.23±0.16）分及（0.31±0.23）分，差异无统计学意
义（P>0.05）；术中发生后囊破裂者仅连续模式组1例，差异无统计学意义（P>0.05）；而术中浅前房发生率分别为
6.25%及 54.84%、术后 1 d角膜水肿的发生率分别为 6.25%及 45.16%、术后 1个月角膜内皮细胞损失率分别为
(0.11±0.11)%及(0.17±0.12)%，角膜内皮六角形细胞比例下降幅度分别为(4.98±4.21)%及(8.25±7.63)%，术中AECP
分别为(416.21±605.87)及(1144.77±715.95)，爆破模式组较连续模式组均有显著降低(P<0.05)。结论 前房维持
器下爆破与连续两种模式均能安全、有效、简化、易行地实施硬核白内障超声乳化摘除术，均为理想的术式选择，
但两种方法比较，前房维持器下爆破超声能量模式可明显降低超声乳化白内障吸除术的AECP，还可以减轻眼内
组织的损伤程度，降低角膜水肿的发生率，减少角膜内皮细胞损伤率，值得推广使用。

      【关键词】 前房维持器；硬核白内障；角膜内皮细胞

      【中图分类号】 R779.6 【文献标识码】 A 【文章编号】 1003—6350（2013）21—3161—03


Effect of hard nucleus cataract with burst and continuous mode during phacoemulsification under anterior
chamber maintenance on corneal endothelial cell.
CHEN Guang-sheng, WANG Dong-mei, DU Yi, HUANG Hong-bo.
Department of Ophthalmology, Liuzhou Eye Hospital, Liuzhou 545001, Guangxi, CHINA

【Abstract】 Objective To evaluate the effect of hard nucleus cataract with burst and continuous mode during
phacoemulsification under anterior chamber maintenance on corneal endothelial cell. Methods Sixty-three patients
(63 eyes) of Ⅳ grade hard nuclear cataract treated by phacoemulsification and intraocular lens implantation were di-
vided into two groups randomly: burst mode group (n=32, 32 eyes, burst mode under the anterior chamber maintainer,
continuous mode group (n=31, 31 eyes, continuous mode under anterior chamber maintainer. Intraoperative complica-
tions, postoperative uncorrected distance visual acuity (UCDVA), corneal incision edema, corneal endothelial cell loss
rate, the proportion of hexagonal cells, accumulated energy complex parameters (AECP) were recorded. The patients
were followed up for 1 month. Results The difference on UCDVA (changed to logMAR score) 1 month after treat-
ment of the two groups was not statistically significant, (0.23±0.16) and (0.31±0.23), respectively. Intraoperative posteri-
or capsular rupture was only found in the continuous mode group (1 case), showing no statistically significant difference
with that in the burst mode group (0 case), P>0.05. In the burst mode group, the shallow anterior chamber incidence, cor-
neal edema 1 day after surgery, corneal endothelial cell loss rate 1 month postoperative, the percentage of hexagonal
cells of the corneal endothelium decline and the ACEP intraoperative [6.25%, 6.25%, (0.15±0.11)%, (4.98±12.21)%,
(416.21±605.87), respectively] were significantly reduced compared with the continuous mode group [54.84%, 45.16%,
(0.17±0.12)%, (8.25±7.63)%, (1144.77±715.95)], P<0.05. Conclusion Hard nucleus cataract with burst and continu-
ous mode during phacoemulsification under anterior chamber maintenance are both safe, effective, simplified and easy
to implement, but the burst mode can significantly reduce the phacoemulsification surgery ACEP and the extent of tissue
damage within the eye, which lead to lower incidence of corneal edema and rate of corneal endothelial cell damage.

      【Key words】 Anterior chamber maintenance; Hard nucleus cataract; Corneal endothelial cell