摘要目的 评价以角膜缘为基底的结膜瓣在手法小切口白内障手术中应用的效果.方法 在基层医院扶贫防盲活动中老年性白内障87例(87眼),按分层随机法随机分为以角膜缘为基底的结膜瓣手术组(A组)44例,和以穹隆为基底的结膜瓣手术组(B组)43例.比较两组的术中后囊破裂的发生率,手术耗时以及术后1、7和30 d切口暴露的发生率.结果 A组的术中后囊破裂发生率为4.55％ (2/44),平均手术时间为(7.48 ±2.12) min,1、7和30 d的切口暴露发生率依次为9.09％ (4/44)、0％ (0/44)、0％(0/44),B组的相应数据依次分别为4.65％(2/43),(8.03±1.98)min,25.58(11/43)、20.93％ (9/43)、9.3％ (4/43).A组术后第1、7和30 d的切口暴露发生率较B组低,差异均有统计学意义(x2 =4.145,10.272,4.290;P=0.042,0.001,0.038).两组的后囊破裂发生率差异无统计学意义(x2=0.001,P=0.981).A组手术时间较B组短,差异有统计学意义(t=-2.430,P=0.038).结论 角膜缘为基底的结膜瓣应用于手法小切口白内障中使手术时间缩短,而且切口暴露的发生率较低,进一步提高了手术安全性.

abstractsObjective To evaluate the clinical effect of limbus-based conjunctival flap in manual small incision cataract surgery.Methods Eighty-seven eyes of 87 patients with age related cataract were eligible for cataract surgery during one poverty alleviation and blindness prevention screening program at basic hospital.Stratified random sampling was used to randomly divide all patients into limbus-based group (group A) and fornix-based group (group B).The differences between the two groups in surgical time,rate of posterior capsular rupture during the operation,and exposure rate of surgical incision at 1,7 and 30 days after surgery were analyzed.Results Forty-four eyes in group A,the rate of posterior capsular rupture during the operation was 4.55％ (2/44) and mean surgical time was(7.48 ± 2.12)min;the exposure rate of surgical incision at 1,7 and 30 days after surgery was 9.09％ (4/44),0％ (0/44),0％ (0/44),respectively.The corresponding figures for group B were 4.65％ (2/43),(8.03 ± 1.98) min,25.58％ (11/43),20.93％ (9/43) and 9.3％ (4/43).Compared to group B,exposure rate of surgical incision of group A at 1,7 and 30 days after surgery was lower (x2 =4.145,10.272,4.290;P =0.042,0.001,0.038) and surgical time was shorter (t =-2.430,P =0.038).There was no significant difference in rate of posterior capsular rupture during the operation between the two groups (x2 =0.001,P =0.981).Conclusion Limbus-based conjunctival flap can shorter the surgical time and lower the exposure rate of surgical incision in manual small incision cataract surgery,which can further improve the safety of cataract surgery.