摘要目的 评估飞秒激光前囊膜切开在膨胀期白色白内障吸除手术中的效果.方法 回顾性系列病例研究.连续收集2014年6月至2015年6月在武汉爱尔眼科医院行超声乳化白内障吸除手术,并在术前行飞秒激光(Len SX系统)前囊膜切开的膨胀期白色白内障患者50例(50只眼)的临床资料为观察组;行常规的手动连续环形撕囊术的50例(50只眼)膨胀期白色白内障患者为对照组1,行飞秒激光前囊膜切开术50例(50只眼)其他类型白内障患者为对照组2.分析各组术中前囊膜放射状撕裂、后囊膜破裂及玻璃体脱出等并发症的情况;观察经过染色处理后的观察组和对照组2的游离的前囊膜的显微图像;并在术后1、3、6个月和1年使用德国Oculus公司的Pentacam三维眼前节测量系统采集3组各眼Scheimplug图像.采用SPSS19.0软件包分析数据.观察组和对照组术中并发症比较采用Fisher精确检验.各组IOL的倾斜度和偏心量行单因素方差分析,采用SNK-q检验进行不同随访时间组的两两比较.结果 150例患者年龄50～86岁,男性72例,女性78例.观察组有2例(4％)发生前囊膜放射状撕裂,6例发生舌状粘连(12％),2例(4％)前囊膜不完全切开,1例(2％)发生后囊膜破裂和玻璃体脱出;对照组1有8例(16％)发生前囊膜放射状撕裂,其中有3例(6％)发生后囊膜破裂和玻璃体脱出,观察组前囊膜放射状撕裂及后囊破裂玻璃体脱出例数明显低于对照组1,差异有统计学意义(P＜0.05);对照组2均成功完成手术,IOL均顺利植入囊袋内且居中性良好,未发生囊袋破裂和玻璃体脱出,与观察组差异有统计学意义(P＜0.05).术后1年随访时观察组和对照组2中无明显IOL倾斜和偏心,对照组1各时间段IOL在水平和垂直方向上的偏心值和倾斜度明显高于观察组(F值分别为2.31、1.10、2.78、2.90)和对照组2(F值分别为2.50、2.32、2.56、2.18)差异有统计学意义(P＜0.05).结论 飞秒激光前囊膜切开位置精确居中,形状正圆,避免术后因囊袋不对称收缩引起的IOL偏心和倾斜,从而可保证术后视觉质量的长期稳定.

abstractsObjective To assess the effect of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery.Methods Retrospective case series study.One hundred and fifty cataract patients (150 eyes) from June 2014 to June 2015 in Wuhan Aier ophthalmology hospital were enrolled in this study.They were divided into three groups:50 intumescent white cataract patients (50 eyes) in the study group were performed femtosecond laser-assisted capsulotomy (LenSx system) operation selectively.Fifty intumescent white cataract patients (50 eyes) underwent normal manual continuous circular capsulorhexis as the control group 1.Fifty other types cataract patients (50 eyes) underwent femtosecond laser-assisted capsulotomy as the control group 2.To observe the complications such as radial tear in anterior capsule,posterior capsule rupture and vitreous prolapse occurred during operations in each group respectively.The microscopic images of the free anterior capsule after dyeing were observed in the study group and the control group 2.Using the German company Oculus Pentacam three-dimensional anterior eye segment system to collect the Scheimplug images of each group at 1,3,6 months and 1 year after operation.The data were analyzed by SPSS19.0 software package.Complications during operations in all groups were compared with Fisher exact test.The eccentricity and tilt of IOL in each group were analyzed by single factor analysis of variance.The SNK-q test was used to compare the different follow-up time groups.Results One hundred and fifty patients aged from 50 to 86 years old,including 72 male cases and 78 female cases.In study group,radial tear in anterior capsule occurred in 2 eyes (4％),adherent tongue-like capsule adhesion was found in 6 eyes (12％),incomplete capsulotomy button happened in 2 eyes (4％),and posterior capsule rupture and vitreous prolapse occurred in 1 eye (2％).In the control group 1,radial tear in anterior capsule occurred in 8 eyes (16％) and posterior capsule rupture and vitreous prolapse occurred in 3 eyes (6％).The cases number of radial tear in anterior capsule and posterior capsule rupture and vitreous prolapse in the study group was obviously lower than the control group 1.The difference was statistically significant (P＜ 0.05).In the control group 2,all 50 eyes were successfully completed.The implantation was uneventful and the IOL was centered.And posterior capsular rupture and vitreous prolapse did not occur.The difference was statistically significant between the study group and the control group 2 (P＜0.05).After 1 year follow-up,the study group and the control group 2 showed no significant IOL tilt and eccentricity.The eccentricity and tilt of IOL in horizontal and vertical direction in control group 1 were significantly higher than those in the study group (F was 2.31,1.10,2.78 and 2.90 respectively) and control group 2 (F was 2.50,2.32,2.56 and 2.18respectively).The difference was statistically significant (P＜0.05).Conclusions Femtosecond laser-assisted anterior capsulotomy is accurate circle and center to avoid IOL eccentricity and tilt caused by capsular bag contraction asymmetrically after implantation,so as to ensure the long-term stability of the visual quality postoperatively.