本文選題：高度近視 + 小切口手法碎核��； 參考：《瀘州醫(yī)學院》2013年碩士論文

【摘要】：目的：探討，觀察并分析小切口白內(nèi)障手法摘除(manual small incisionsurgery,MSICS)和超聲乳化摘除(Ultrasonic Phacoemulsification,USPhco)聯(lián)合低度數(shù)折疊式人工晶狀體植入術(shù)的手術(shù)技術(shù)和臨床效果，為高度軸性近視并發(fā)白內(nèi)障的手術(shù)治療提供參考。 方法:收集176例(198只眼)白內(nèi)障患者，眼軸≥26mm的88例（101眼），分成三組（A1組:32例33眼，B1組：31例36眼，C1組：25例32眼）；眼軸≥22mm，≤24mm的88例（97眼）分為三組（A2組：34例36眼，B2組：35例37眼，C2組：19例26眼）。A1組、A2組行小切口白內(nèi)障手法碎核乳化摘除術(shù)聯(lián)合折疊式人工晶狀體植入；B1組、B2組行超聲乳化術(shù)聯(lián)合折疊式人工晶狀體植入。C1組、C2組行小切口白內(nèi)障手法劈核摘除術(shù)聯(lián)合折疊式人工晶狀體植入。分別測量患者術(shù)后1天、3天、1周、1月、3月的視力、散光、眼壓、角膜內(nèi)皮細胞計數(shù)、眼軸及觀察術(shù)中術(shù)后并發(fā)癥發(fā)生率。采用SPSS19.0統(tǒng)計軟件包進行統(tǒng)計分析，獨立兩樣本均數(shù)比較采用獨立樣本T檢驗，多個樣本之間用方差分析，組間均數(shù)的兩兩比較采用的是LSD法。兩樣本相關(guān)性用Pearson相關(guān)分析。P0.05表示有統(tǒng)計學意義，r0.300為無相關(guān)，r=0.300～0.499為低度相關(guān)，，r=0.500～0.800為中度相關(guān)，r0.800為高度相關(guān)。 結(jié)果：1、術(shù)前術(shù)后，A1組、B1組、A2組、B2組、C1組、C2組的視力差異較大，比較有統(tǒng)計學意義（F=5.247，P=0.003＜0.05）；術(shù)前，A1組、B1組的視力相似（P＞0.05），兩組的視力均優(yōu)于C1組（P＜0.05)；術(shù)后1天，A1組、B1組的視力較C1組的好（P＜0.05)；術(shù)后3天、1周、1月、3月，A1組、B1組、C1組的視力無統(tǒng)計學差異（P＞0.05）；術(shù)前，A2組和B2組視力無統(tǒng)計學差異（P＞0.05），與C2組比較，后者的視力較差（P＜0.05）；術(shù)后1天，A2組、B2組的視力較C2組的好（P＜0.05)；術(shù)后3天、1周、1月、3月，A2組、B2組、C2組的視力無統(tǒng)計學差異（P＞0.05）；單純白內(nèi)障組（A2組、B2組、C2組）的術(shù)前、術(shù)后視力均比高度近視組（A1組、B1組、C1組）的好，差異有顯著意義（P＜0.05)；2、六組的角膜內(nèi)皮細胞丟失量有顯著差異性意義(P＜0.05)；A1組與B1組比較，無顯著差異（P＞0.05）；A1組與A2組的差異具有統(tǒng)計學意義（P＜0.05），A1組與C1組比較，C1組丟失量更大（P＜0.05）；B1與B2組比較，有差異（P＜0.05），B2組較C2組丟失量少（P＜0.05）；A2組與B2組比較，無明顯差異（P＞0.05）；C1組與C2組比較，差異有顯著性意義（P＜0.05）3、六組眼壓波動比較，各有不同（P＜0.05）；術(shù)后1天、3天、1周時，A1組的眼壓波動小于B1組、C1組（P＜0.05）；術(shù)后1個月、3個月時，A1組、B1組的眼壓波動差異無顯著性意義（P＞0.05），A1組的眼壓波動小于C1組（P＜0.05）; A1組、B1組及C1組的眼壓波動均于術(shù)后1月趨于穩(wěn)定（P＞0.05）；術(shù)后1天、3天、1周、1個月、3個月時，A2組、B2組的眼壓波動沒有顯著不同（P＞0.05），A2組小于C2組的眼（P＜0.05）；A2組、B2組及C2組的眼壓波動均于術(shù)后1周穩(wěn)定（P＞0.05）。4、術(shù)前術(shù)后，用配對t檢驗，A1組、B1組、A2組、B2組、C2組的術(shù)前眼軸平均值均大于術(shù)后，但其差異無統(tǒng)計學意義（P＞0.05）；C1組術(shù)后眼軸平均值小于術(shù)前（P＜0.05)；術(shù)前術(shù)后的眼軸平均值差異小，無統(tǒng)計學意義（P＞0.05）；組間比較，A1組、B1組、C1組與A2組、B2組、C2組的眼軸測量誤差有顯著差異，具有統(tǒng)計學意義（P＜0.05)；A1組、B1組較C1組的眼軸測量誤差小（P＜0.05)；A2組、B2組較C2組的眼軸測量誤差�。≒＜0.05)。5、預計屈光度與實際屈光度的比較用配對t檢驗，A1組、B1組和C1組的預計屈光度較實際屈光度大，其差異有統(tǒng)計學意義（P＜0.05）；A2組、B2組及C2組的預計屈光度與實際屈光度相似，無明顯差異（P＞0.05）；屈光度度誤差的比較用LSD法，A1組、B1組、C1組與A2組、B2組、C2組的屈光度誤差有顯著差異，具有統(tǒng)計學意義（F=16.24,P＜0.05)；A1組和B1組屈光度誤差比較，無統(tǒng)計學意義（P＞0.05）；A1組和C1組屈光度誤差不同（P＜0.05）；A2組和B2組屈光度誤差比較，無統(tǒng)計學意義（P＞0.05）；A2組較C2組屈光度誤差小（P＜0.05）。6、高度近視組（A2組、B2組及C2組）中，屈光度誤差與眼軸長度、眼軸測量誤差均有相關(guān)性(r＞0.300)，并且隨著眼軸的增長，其相關(guān)性增大；在單純白內(nèi)障組（A2組、B2組及C2組）中，屈光度誤差的絕對差值與眼軸無相關(guān)(r＜0.300)。7、A1組、B1組、A2組、B2、C1組及C2組六組比較，術(shù)前及術(shù)后的角膜散光，差異沒有統(tǒng)計學意義（P＞0.05)；A1組的術(shù)前與術(shù)后比較，用配對t檢驗，術(shù)前與術(shù)后1天、術(shù)后3天、術(shù)后1月、術(shù)后3個月的差異有統(tǒng)計學意義(P=0.00＜0.05)，術(shù)前的散光與術(shù)后1周的散光比較，無明顯差異（P=0.356＞0.05）；B1組、A2組、B2組、C1組、C2組用上述t檢驗，得出與A1組相似的結(jié)果：術(shù)前與術(shù)后1天、術(shù)后3天、術(shù)后1月、術(shù)后3個月的差異有統(tǒng)計學意義(P＜0.05)，術(shù)前的散光與術(shù)后1周的散光比較，無明顯差異（P＞0.05）。A1、B1、A2、B2、C1、C2六組的術(shù)前角膜散光均以逆規(guī)性散光為主，術(shù)后1天、3天、1周時，順規(guī)性散光比例增加1個月后逆規(guī)性散光增加，3個月后，逆規(guī)性散光所占比例超過術(shù)前。用R×C列聯(lián)表資料的χ2檢驗，比較術(shù)前、術(shù)后的角膜散光軸向構(gòu)成比，無統(tǒng)計學差異（P＞0.05）。8.術(shù)后1天、3天、1周、1個月、3個月，A1組、B1組、A2組、B2組、C1組、C2組的SIA，采用方差分析統(tǒng)計，其值無明顯差異（P＞0.05）;六組的術(shù)后SIA,進行配對t檢驗，術(shù)后1天到術(shù)后1月的SIA有差異（P＜0.05），術(shù)后1月與術(shù)后3月的SIA相似（P＞0.05）；A1組術(shù)后SIA比較，于3個月時趨于穩(wěn)定; B1組、A2組、B2組、C1組、C2組的術(shù)后SIA比較，結(jié)果同A1組及B1組。 結(jié)論：1.帶球結(jié)膜蒂的小切口白內(nèi)障手法碎核乳化摘除術(shù)術(shù)后的視力、眼壓、散光與超聲乳化白內(nèi)障摘除術(shù)相比并無明顯差異，兩者術(shù)后效果相似，但前者手術(shù)可控性好，不易出現(xiàn)嚴重并發(fā)癥，對眼表損傷小。對Ⅰ～Ⅲ級核的白內(nèi)障患者是較好的手術(shù)選擇。2.對Ⅳ、Ⅴ級核的白內(nèi)障患者，行帶球結(jié)膜蒂的中小切口白內(nèi)障手法劈核摘除術(shù)，其術(shù)后視力恢復可，散光小，術(shù)后并發(fā)癥較少，且可規(guī)避超聲乳化術(shù)的手術(shù)風險及并發(fā)癥。3.對于高度近視并發(fā)性白內(nèi)障并核硬的患者而言，術(shù)中操作難度大，術(shù)后角膜內(nèi)皮損傷較重，且術(shù)后眼壓波動大。故可建議早期手術(shù)，減少手術(shù)風險，提高術(shù)后效果。4.眼軸測量的準確與否直接影響白內(nèi)障患者術(shù)后的視覺質(zhì)量。只有提高眼軸長測量的準確性才能減少患者術(shù)后屈光度誤差，讓患者獲得理想的視覺質(zhì)量。
[Abstract]:Objective: To study, observation and analysis of small incision cataract extraction technique (manual small incisionsurgery, MSICS) and phacoemulsification (Ultrasonic Phacoemulsification USPhco) surgical technique and clinical effect of combined with low degree of foldable intraocular lens implantation and to provide reference for the surgical treatment of high myopia with cataract.
Methods: 176 cases (198 eyes) with cataract, 88 cases (101 eyes) of 26mm, were divided into three groups (group A1: 32 cases, 33 eyes, 31 cases 36 eyes, group C1: 25 cases 32 eyes); 88 cases (97 eyes) of ocular axis more than 22mm, < < 24mm > (A2 group: B2 group: C2 group: C2).A1 group, A2 group underwent small incision cataract manipulation nucleus. Emulsion extirpation combined with foldable intraocular lens implantation; group B1 and group B2 were treated with phacoemulsification combined with foldable intraocular lens implantation in group.C1. Group C2 had small incision cataract manipulation and foldable intraocular lens implantation. The visual acuity, astigmatism, intraocular pressure and corneal endothelium were measured at 1 days, 3 days, 1 weeks, January, and March respectively. The incidence of cell counts, ocular axis and intraoperative postoperative complications was statistically analyzed by SPSS19.0 software package. Independent samples were compared with independent sample T test, multiple samples were analyzed with variance, and the 22 comparison of intergroup average was LSD method. Two sample correlation used Pearson correlation analysis.P0.05 to show statistics. In terms of learning meaning, r0.300 is uncorrelated, r=0.300 to 0.499 is low correlation, r=0.500 to 0.800 is moderately correlated, and r0.800 is highly correlated.
Results: 1, before and after operation, the visual differences between group A1, group B1, group A2, group B2, group C1, group C2 and group C2 were significant (F=5.247, P=0.003 < 0.05); the visual acuity of group A1 and B1 group was similar (P > 0.05) before operation, and the visual acuity of group two was better than that of the C1 group (< 0.05); 1 days after the operation, the visual acuity of the group was better than that of the group (0.05); and 3 days, 1 weeks, January, 3 after the operation. There was no significant difference in visual acuity between group A1, group B1 and group C1 (P > 0.05). Before operation, there was no significant difference in visual acuity between group A2 and B2 group (P > 0.05). Compared with group C2, the visual acuity of the latter was poor (P < 0.05); the vision of the latter was better than that of the C2 group at 1 days, A2, and B2 group (0.05); the 3 days, 1 weeks, January, March, the group, and the group had no statistical difference (0). .05); the visual acuity of the simple cataract group (group A2, group B2, C2) was better than that of the high myopia group (group A1, B1, C1), and the difference was significant (P < 0.05). 2, the loss of corneal endothelium in the six groups was significantly different (P < 0.05); there was no significant difference between the A1 group and the B1 group (P > 0.05). Statistical significance (P < 0.05), compared with group C1, group A1 was more lost in C1 (P < 0.05), and there was a difference between B1 and B2 group (P < 0.05), and the loss of B2 group was less than that of C2 group (P < 0.05), and there was no significant difference between A2 group and group (0.05). At 1 days, 3 days and 1 weeks after operation, the intraocular pressure fluctuation in group A1 was less than that of group B1 and group C1 (P < 0.05). There was no significant difference in intraocular pressure fluctuation between group A1 and B1 group (P > 0.05) at 1 months and 3 months after operation (P > 0.05), and group A1 was less than C1 (P < 0.05) in A1 group (P < 0.05) in A1 group, and in B1 group and group after operation in January (0.05); postoperative 1 days postoperatively. In 3 days, 1 weeks, 1 months, 3 months, group A2 and group B2 had no significant difference in intraocular pressure (P > 0.05), group A2 was less than that in group C2 (P < 0.05); the intraocular pressure fluctuations in group A2, B2 and C2 were all stable (P > 0.05) 1 weeks after operation (P > 0.05).4. There was no statistical significance (P > 0.05), and the average value of ocular axis in group C1 was less than that before operation (P < 0.05), and the mean value of ocular axis was small and no statistical significance (P > 0.05) before and after operation; compared with group A1, B1, C1 group and A2 group, B2 group and C2 group, there were significant differences between groups (P < 0.05); A1 group was more than group. The error of ocular axis measurement was small (P < 0.05); in group A2, group B2 was smaller than that in group C2 (P < 0.05).5. Compared with actual refractive index, the predicted diopter of group A1, B1 group and C1 group was larger than actual refractive index, and the difference was statistically significant (P < 0.05). The photometric similarity was no significant difference (P > 0.05). The diopter error was compared with LSD, A1, B1, C1 and A2, B2 group and C2 group, which was statistically significant (F=16.24, P < 0.05), and there was no significant difference between A1 and B1 group (0.05). 5): the diopter error of group A2 and B2 group was not statistically significant (P > 0.05); the refractive error of group A2 was smaller than that of C2 group (P < 0.05).6. In the high myopia group (A2 group, B2 group and C2 group), the refractive error was correlated with the eye axis length and the ocular axis measurement error (r > 0.300), and the correlation increased with the increase of the ocular axis; in the simple cataract, the correlation was increased and the cataract was increased in simple cataract. In group A2, group B2 and group C2, the absolute difference of diopter error was compared with the ocular axis (r < 0.300).7, A1 group, B1 group, A2 group, B2, C1 group and C2 group. There was no statistical difference between preoperative and postoperative corneal astigmatism (P > 0.05). The preoperative and postoperative comparison, preoperative and 1 days, 3 days after operation, and January, The difference between 3 months after operation was statistically significant (P=0.00 < 0.05). There was no significant difference between preoperative astigmatism and astigmatism after 1 weeks (P=0.356 > 0.05); group B1, group A2, group B2, group C1, and group C2 obtained the similar results with the A1 group: 1 days before operation, 3 days after operation, January after operation, 3 months after operation (P < 0.05), there was no significant difference between preoperative astigmatism and astigmatism after 1 weeks (P > 0.05).A1, B1, A2, B2, C1, and C2 six, the preoperation corneal astigmatism was mainly reverse optical astigmatism, 1 days, 3 days, 1 weeks postoperatively, the proportion of paraminic astigmatism increased after 1 months, and the proportion of reverse optical astigmatism after 3 months was more than before operation. R x C contingency table was used. The X-ray 2 test was used to compare the axial component ratio of corneal astigmatism before and after operation. There was no statistical difference (P > 0.05) 1 days, 3 days, 1 weeks, 1 months, 3 months, group A1, group B1, group A2, B2, C1, C2, and there was no significant difference (P > 0.05) with variance analysis (P > 0.05); the six group after operation SIA, 1 days after operation to January after the operation. The difference in SIA (P < 0.05) was similar to that of SIA after operation in January and March after operation (P > 0.05); SIA in group A1 was more stable after 3 months, and in group B1, A2, B2, C1, C2.
Conclusion: 1. the visual acuity, intraocular pressure, astigmatism and phacoemulsification after cataract extraction and phacoemulsification are not significantly different from those of phacoemulsification. The results are similar, but the former has good controllability, no serious complications and small ocular surface injury. It is a better operation to select.2. for patients with cataract in grade IV and grade V, with small incision and small incision for cataract surgery. The postoperative visual acuity, astigmatism, and postoperative complications are less, and the risk of phacoemulsification and complications can be avoided in patients with high myopia complicated with cataract and hard nuclear. It is difficult to operate in the operation, the corneal endothelium injury is heavy after operation, and the intraocular pressure fluctuates greatly after operation. Therefore, early operation can be suggested to reduce the risk of operation and improve the accuracy of.4. eye axis measurement after operation. Poor, let the patient get the ideal visual quality.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R779.66

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