手法小切口白内障手术中不同核娩出技术导致的角膜内皮细胞丢失——随机对照试验

Corneal endothelial cell loss with different techniques of nucleus delivery in Manual Small Incision Cataract Surgery- Randomized Controlled Trial.

作者信息

Mol Fincy, Nagarajan Swathi, Ar Rajalakshmi, Govindasamy Ezhumalai

机构信息

Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV), Puducherry, India.

出版信息

J Cataract Refract Surg. 2024 Dec 24;51(4):282-6. doi: 10.1097/j.jcrs.0000000000001605.

DOI:10.1097/j.jcrs.0000000000001605

PMID:39716418

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11980896/

Abstract

PURPOSE

To compare corneal endothelial loss in manual small incision cataract surgery (MSICS) following three different techniques of nucleus delivery (Viscoexpression, Irrigating Vectis, Phacosandwich).

SETTING

Mahatma Gandhi Medical College and Research Institute, Puducherry, India.

DESIGN

Prospective, single blinded, randomized controlled trial.

METHODS

Willing patients > 40years of age with immature cataract and posted for MSICS were recruited for the study. Those with systemic or ocular comorbidities which may influence corneal endothelium, dilated pupil size of <5mm, intraoperative complications and postoperative corneal haze were excluded. They were randomly divided to one of the three groups (Group 1- Viscoexpression, Group 2- Irrigating Vectis, Group 3- Phacosandwich) for nucleus delivery. Visual acuity and corneal endothelial parameters were recorded preoperatively and postoperatively at 6-8weeks.

RESULTS

A total of 90 patients with mean age of 59.13 ± 9.42 years (range 40-82years) were studied with 30 patients in each group. Following MSICS there was a 12.12% (p=0.001) endothelial cell loss. It was 10.81% in viscoexpression group, 11.3% in irrigating vectis group and 14.28% in phacosandwich group. Post hoc analysis with Dunn Bon ferroni test showed endothelial cell loss following viscoexpression and irrigating vectis methods of nucleus delivery were comparable (p=0.096) and significantly lesser (p<0.001) than in Phacosandwich group.

CONCLUSION

There was significant endothelial cell loss following MSICS. Nucleus delivery by viscoexpression and irrigating vectis had similar endothelial cell loss while it was greater with phacosandwich technique.

摘要

目的

比较手动小切口白内障手术（MSICS）中采用三种不同核娩出技术（黏弹剂娩核法、灌注式晶状体钩娩核法、超声乳化三明治法）后的角膜内皮细胞损失情况。

地点

印度本地治里市圣雄甘地医学院及研究所。

设计

前瞻性、单盲、随机对照试验。

方法

招募年龄大于40岁、患有未成熟白内障且计划行MSICS的患者参与研究。排除患有可能影响角膜内皮的全身或眼部合并症、散瞳后瞳孔直径小于5mm、术中并发症及术后角膜混浊的患者。将他们随机分为三组（第1组-黏弹剂娩核法，第2组-灌注式晶状体钩娩核法，第3组-超声乳化三明治法）之一进行核娩出。术前及术后6 - 8周记录视力和角膜内皮参数。

结果

共研究了90例患者，平均年龄59.13±9.42岁（范围40 - 82岁），每组30例。MSICS术后角膜内皮细胞损失率为12.12%（p = 0.001）。黏弹剂娩核法组为10.81%，灌注式晶状体钩娩核法组为11.3%，超声乳化三明治法组为14.28%。采用邓恩 - 邦费罗尼检验进行事后分析显示，黏弹剂娩核法和灌注式晶状体钩娩核法的核娩出术后角膜内皮细胞损失情况相当（p = 0.096），且显著低于超声乳化三明治法组（p < 0.001）。