飞秒激光辅助白内障手术与传统超声乳化手术中屈光预测性及内皮细胞损失的比较：为期6个月随访的前瞻性随机试验

Comparison of refractive predictability and endothelial cell loss in femtosecond laser-assisted cataract surgery and conventional phaco surgery: prospective randomised trial with 6 months of follow-up.

作者信息

Krarup Therese, Ejstrup Rasmus, Mortensen Anouck, la Cour Morten, Holm Lars Morten

机构信息

Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark.

出版信息

BMJ Open Ophthalmol. 2019 Mar 1;4(1):e000233. doi: 10.1136/bmjophth-2018-000233. eCollection 2019.

OBJECTIVE

Femtosecond laser-assisted cataract surgery (FLACS) decreases the use of energy and provides a more precise capsulorhexis compared with conventional phaco surgery (CPS). The purpose of this study was to examine if the lower energy use in FLACS caused less endothelial cell loss compared with CPS and if there was a difference in refractive predictability between CPS and FLACS.

METHODS AND ANALYSIS

This was a randomised controlled study of 96 patients with a 6-month follow-up comparing one eye surgery by FLACS and the contralateral eye operated by CPS (divide and conquer technique). Both eyes had intraocular aspheric lenses implanted. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), central corneal endothelial cell count and hexagonality (non-contact endothelial cell microscope) were assessed preoperatively at 40 and at 180 days postoperatively.

RESULTS

The mean phaco energies were 6.55 (95% CI 5.43 to 7.66) and 9.77 (95% CI 8.55 to 10.95) U/S (p<0.0001) by FLACS and CPS, respectively. At day 40, the mean endothelial cell loss (ECL) was 344 cells/mm (95% CI 245 to 443) by FLACS (12.89%) and 497 cells/mm (95% CI 380 to 614) by CPS (18.19%) (p=0.027). At day 180, ECL was 362 cells/mm (95% CI 275 to 450) in FLACS (13.56%) and 465 cells/mm (95% CI 377 to 554) in CPS (17.03%) (p=0.036).The mean absolute difference from the attempted refraction was 0.43 (95% CI 0.36 to 0.51) dioptres (D) at day 40 and 0.46 D (95% CI 0.39 to 0.53) at day 180 by FLACS compared with 0.43 D (95% CI 0.36 to 0.51) at day 40 (p=0.95) and 0.46 D (95% CI 0.37 to 0.52) at day 180 (p=0.91) with CPS.

CONCLUSION

ECL was significantly lower in FLACS compared with CPS at both day 40 and day 180. ECL was correlated to the energy used. We found no difference in refractive predictability or CDVA between the groups.

目的

与传统超声乳化手术（CPS）相比，飞秒激光辅助白内障手术（FLACS）减少了能量的使用，并能提供更精确的撕囊。本研究的目的是探讨与CPS相比，FLACS中较低的能量使用是否导致更少的内皮细胞损失，以及CPS和FLACS在屈光预测性方面是否存在差异。

方法与分析

这是一项对96例患者进行的随机对照研究，随访6个月，比较一眼行FLACS手术，对侧眼行CPS手术（分而治之技术）。双眼均植入了非球面人工晶状体。术前、术后40天和180天评估未矫正远视力、矫正远视力（CDVA）、中央角膜内皮细胞计数和六边形率（非接触式内皮细胞显微镜）。

结果

FLACS和CPS的平均超声乳化能量分别为6.55（95%CI 5.43至7.66）和9.77（95%CI 8.55至10.95）U/S（p<0.0001）。在第40天，FLACS组的平均内皮细胞损失（ECL）为344个细胞/mm²（95%CI 245至443）（12.89%），CPS组为497个细胞/mm²（95%CI 380至614）（18.19%）（p=0.027）。在第180天，FLACS组的ECL为362个细胞/mm²（95%CI 275至450）（13.56%），CPS组为465个细胞/mm²（95%CI 377至554）（17.03%）（p=0.036）。与预期屈光度的平均绝对差值在第40天FLACS组为0.43（95%CI 0.36至0.51）屈光度（D），第180天为0.46 D（95%CI 0.39至0.53），而CPS组在第40天为0.43 D（95%CI 0.36至0.51）（p=0.95），第180天为0.46 D（95%CI 0.37至0.52）（p=0.91）。