无结膜瓣与有结膜瓣小切口白内障摘除术人工晶状体植入的临床评估

【】　目的　观察在表面麻醉下不作结膜瓣和传统的以穹窿为基底结膜切开的小切口白内障摘除联合5.5mm直径人工晶状体植入术的临床效果。　方法　收集2007年1月－2010年12月资料较完整的老年性白内障160例，将160例320只眼随机分成两组，每组各80例160只眼。在表面麻醉下行小切口白内障手术。A组不做结膜瓣，行长5.5mm角巩膜缘的平行切口；B组行以穹窿为基底的传统的结膜瓣，做长5.5mm角巩膜平行切口；两组均行手法小切口白内障劈核摘除联合5.5mm直径硬质人工晶状体植入。观察术后效果及术后并发症。　结果　术后1个月，患者眼部舒适者A组154只眼（96.25%），B组141只眼（88.13%），两组差异有统计学意义（χ2=7.332，P0.05）；1周，A组130只眼（81.25%），B组132只眼（82.25%）（χ2=0.084，P>0.05）；1个月，A组138只眼（86.25%），B组139只眼（86.86%）（χ2=0.027，P>0.05）；角膜水肿于术后2周后均消退。　结论　在表面麻醉下不做结膜瓣较做结膜瓣小切口白内障劈核摘除术联合人工晶状体植入术省时、对眼表面破坏小，角巩膜切口较小且较为隐闭，术后恢复快。在基层医院是一种较好的白内障手术方法。【Abstract】　Objective　Toobservetheclinicaleffectofnon-conjunctivalflapsandtraditionalconjunctivalflapschoperextracapsularcataractextraction(ECCE)onpatientswithsenilecataracts.　Methods　Theclinicaldataof160patientswithcataractsbetweenJanuary2007andDecember2010werecollected.Thepatientswererandomlydividedintotwogroupswith80patients(160eyes)ineachgroup.ThepatientsingroupAunderwentthesmall-incisionchoperECCEsurgerywithnon-conjunctivalflaps;whilethepatientsingroupBunderwentthetraditionalconjunctivalflaps.Thenthetotaleffectiverate,incidenceofcomplications,andsatisfactionrateofthetwogroupswereanalyzedandcompared.　Results　Onemonthafterthesurgery,thecomfortwasfoundin154eyes(96.25%)ingroupAandin141eyes(88.13%)ingroupB;thedifferencewassignificant(χ2=7.332，P0.05);oneweek130eyes(81.25%)ingroupAand132eyes(82.25%)ingroupB(χ2=0.084，P>0.05);onemonth138eyes(86.25%)ingroupAand139eyes(86.86%)ingroupB(χ2=0.027，P>0.05).Thecorneaedemawasalleviatedhalfmonthafterthesurgery.　Conclusion　Comparedwiththetraditionalway,non-conjunctivalflapsECCEmaysavethesurgicaltime,reducethedamageoftheocularsurface,improvethevisualacuityandreceivedhighersatisfactionrateandlessconjunctivecomplication,whichisagoodsurgicalmethodinlocalhospital.