Cavallini Gian Maria, Verdina Tommaso, Forlini Matteo, Volante Veronica, De Maria Michele, Torlai Giulio, Benatti Caterina, Delvecchio Giancarlo
Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy.
Clin Ophthalmol. 2016 May 26;10:979-87. doi: 10.2147/OPTH.S103540. eCollection 2016.
To determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons.
Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software.
Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B.
B-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.
确定接受培训的外科医生进行双手微切口白内障手术（B-MICS）的疗效，在长期随访中评估临床结果、后囊膜混浊（PCO）发生率和透明角膜切口（CCI）结构，并将结果与经验丰富的外科医生所获结果进行比较。
本研究纳入了62例患者的80只眼睛，这些患者由三名首次使用B-MICS技术的接受培训的外科医生进行手术（A组）。将59例患者接受三名经验丰富的外科医生进行B-MICS手术的80只眼睛作为对照组（B组）。在手术前以及手术后1个月和18个月评估最佳矫正视力、散光、角膜测厚和内皮细胞计数。获取眼前节光学相干断层扫描图像以研究CCI的形态。使用EPCO2000软件评估PCO发生率。
在纳入研究的160例手术中，A组在18个月时平均最佳矫正视力提高为0.343±0.246 logMAR，B组为0.388±0.175 logMAR。我们发现两组均无统计学上显著的诱导散光或角膜测厚变化，而两组术后均有统计学上显著的内皮细胞损失（P<0.05）。A组平均PCO评分为0.163±0.196，而B组为0.057±0.132（P = 0.0025）。A组和B组CCI的平均长度和倾斜度分别为1358±175 µm和1437±256 µm以及141.8°±6.4°和148.7°±5.1°。在所考虑的320个CCI中，关于角膜结构，我们发现A组后伤口回缩和内皮间隙分别为9.8%和11.6%，B组为7.8%和10.8%。
即使在长期随访后评估，接受培训的外科医生进行的B-MICS也是一种有效的手术技术。经验不足的外科医生的PCO发生率更高。与专家外科医生所获结果相比，接受培训的外科医生的角膜切口更短且角度更小。
