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目的探讨超声乳化白内障手术中微爆破模式对前房能量释放与超声时间的影响。设计前瞻性随机对照临床研究。研究对象老年性白内障患者211例(226眼),随机分为微爆破组105例(113眼)与常规连续超声组106例(113眼)。方法两组患者行超声乳化白内障手术,微爆破模式组爆破幅度为30ms,负压为220mmHg,超声能量为60%;连续超声模式组负压为210mmHg,最大超声能量为60%。主要指标术中有效超声能量、超声时间,术后第1天的最佳矫正视力、角膜水肿程度。结果微爆破组和连续超声组,核硬度Ⅰ～Ⅲ级时,术中有效超声能量分别为(3.52±1.58)%,(17.10±7.77)%;超声时间分别为(0.17±0.29)分,(0.99±0.57)分,差异均有统计学意义。术后第1天的最佳矫正视力≥0.5者分别为75眼(79.8%),62眼(65.3%)。核硬度IV～V级时,术中有效超声能量分别为(3.95±1.22)%,(17.33±8.06)%;超声时间分别为(0.25±0.28)分,(1.35±0.79)分,差异均有统计学意义。术后第1天的最佳矫正视力≥0.5者分别为9眼(47.4%),7眼(38.9%)。所有术眼术后第1天角膜水肿程度,微爆破组均较连续超声组轻微。结论在超声乳化白内障手术中,运用微爆破模式,对乳化吸除Ⅰ～Ⅲ级核具有优势;对于IV～V级核,联合拦截劈核技术,也能明显减少前房内能量的释放。
Objective To investigate the effect of micro-burst mode on energy release and ultrasound time in phacoemulsification with phacoemulsification. Design prospective randomized controlled clinical study. A total of 211 patients (226 eyes) with senile cataract were randomly divided into 105 cases (113 eyes) in the micro-burst group and 106 cases (113 eyes) in the conventional continuous ultrasound group. Methods The phacoemulsification cataract surgery was performed in both groups. The blasting amplitude was 30 ms, the negative pressure was 220 mmHg and the ultrasonic energy was 60%. The negative pressure was 210 mmHg and the maximum ultrasonic energy was 60% in the continuous ultrasound mode group. The main indicators of intraoperative effective ultrasonic energy, ultrasound time, best corrected visual acuity after 1 day, the degree of corneal edema. Results In the group of microburst and continuous ultrasound, the intraoperative effective ultrasonic energy was (3.52 ± 1.58)% and (17.10 ± 7.77)%, respectively; the ultrasonic time were (0.17 ± 0.29) and 0.99 ± 0.57) points, the differences were statistically significant. The best corrected visual acuity ≥ 0.5 on the first postoperative day was 75 eyes (79.8%) and 62 eyes (65.3%), respectively. The intracameral effective ultrasonic energy was (3.95 ± 1.22)% and (17.33 ± 8.06)% respectively when the nuclear hardness was in the range of IV ~ V. The time of ultrasound was (0.25 ± 0.28) and (1.35 ± 0.79) Statistical significance. The best corrected visual acuity ≥ 0.5 on the first postoperative day was 9 eyes (47.4%) and 7 eyes (38.9%), respectively. The corneal edema on the first postoperative day in all eyes was slightly lower than that in the continuous ultrasonography group. Conclusion In the phacoemulsification cataract surgery, the use of micro-blasting mode has the advantage of emulsifying aspiration grade Ⅰ ~ Ⅲ nuclei. For the IV-V level nucleus, combined with the interception of cleaved nucleus technique can significantly reduce the release of energy in the anterior chamber.