摘要:
目的:评价小瞳孔白内障超声乳化手术中应用Malyugin Ring瞳孔扩张器的效果.方法:前瞻性病例对照研究.收集临床工作中的小瞳孔白内障患者27例(32眼),分为2组,其中术中采用2把器械瞳孔撕开操作21眼(I组),采用Malyugin Ring瞳孔扩张器扩张瞳孔11眼(I组).所有病例均行3.2 mm透明角膜切口超声乳化白内障吸除IOL植入术,术后1周,1、3、6个月随访,比较手术前后最佳矫正视力(BCVA)、眼压(IOP)、平均角膜曲率、角膜内皮细胞计数、瞳孔大小变化.采用独立样本t检验进行统计分析.结果:所有手术均由同一医师顺利完成,人工晶状体(IOL)100%囊袋内植入,无手术并发症发生.手术前与术后6个月比较:BCVA(LogMAR):I组1.15±0.75 vs.0.30±0.21,I组1.42±1.16 vs 0.30±0.31;IOP:I组(14.7±4.6)mmHg vs.(14.1±6.4)mmHg,I组(16.1±5.1)mmHg vs.(12.4±2.2)mmHg;平均角膜曲率:I组(44.55±1.83)D vs.(44.94±2.70)D,I组(44.72±1.55)D vs.(45.37±1.25)D;角膜内皮细胞计数:I组(2490±498)/mm2 vs.(1486±612)/mm2,I组(2620±989)/mm2 vs.(2089±729)/mm2;瞳孔直径:I组(2.0±0.6)mm vs.(3.3±1.2)mm,I组(2.2±0.8)mm vs.(3.5±1.2)mm.2组间手术前后参数比较,术后角膜内皮细胞计数差异具有统计学意义(t=-2.352,P=0.038),其他参数比较差异均无统计学意义.结论:小瞳孔白内障超声乳化手术时使用Malyugin Ring瞳孔扩张器辅助不影响术后视力恢复和IOP及角膜曲率情况.术后瞳孔较术前扩大,Malyugin Ring有助于减少术中角膜内皮细胞丢失.%Objective: To assess the effect of Malyugin rings in phacoemulsification surgery of cataract in eyes with small pupils. Methods: This was a prospective case-control study. Twenty-seven microcoria cataract cases (32 eyes) were enrolled and divided into two groups. In Group Ⅰ (21 eyes), the pupils were dilated by with two instruments. In Group Ⅱ (11 eyes), the pupils were dilated by Malyugin ring insertion. Clear corneal incisions of 3.2 mm were used in the phacoemulsifications. All cases were followed up postoperatively at 1 week and at 1, 3, and 6 months. Pre- and postoperative values were compared for best corrected visual acuity (BCVA), intraocular pressure, corneal endothelial cell counts, and pupil size. Independent-samples t-tests were used in the analyses. Results: All surgery was completed successfully by the same doctor. All intraocular lenses were implanted within the capsule, and no complications occurred. Measurements for the following pre- and 6-month postoperative parameters were compared: BCVA (LogMAR): Group Ⅰ, 1.15±0.75 vs. 0.30±0.21 and Group Ⅱ, 1.42±1.16 vs. 0.30±0.31; IOP (mmHg): Group Ⅰ, 14.7±4.6 vs. 14.1±6.4 and Group Ⅱ, 16.1±5.1 vs. 12.4±2.2; Average corneal curvature (diopter, D): Group Ⅰ, 44.55±1.83 vs. 44.94±2.70 and Group Ⅱ, 44.72±1.55 vs. 45.37±1.25; Corneal endothelial cell density (cells/mm2):Group Ⅰ, 2490±498 vs. 1486±612 and Group Ⅱ, 2620±989 vs. 2089±729; Pupil diameter (mm): Group Ⅰ, 2.0±0.6 vs. 3.3±1.2 and Group Ⅱ, 2.2±0.8 vs. 3.5±1.2. The parameters of the corneal endothelial cells were statistically different (t=-2.352, P=0.038) after surgery between the two groups, and no statistical difference was found in the other parameters. Conclusions: Use of the Malyugin ring in microcoria cataract phacoemulsification does not affect the 6-month postoperative visual acuity, intraocular pressure, or average corneal curvature. The pupils were enlarged before surgery. Malyugin ring can help reduce the loss of corneal endothelial cells in surgery.