| BACKGROUND AND OBJECTIVEBy comparing the effectiveness of small incision extracapsular cataract extraction (small incision ECCE) and phacoemulsification, to evaluate the efficacy and safety of small incision ECCE.PATIENTS AND METHODS60 consecutive senile cataract patients scheduled for cataract surgery were randomly allocated to two groups: group I include 30 patients witfi senile cataract ( Iff ~ IV grade hard nucleus) which undergo phacoemulsification; group II : 30 with senile cataract ( Iff ~ IV grade hard nucleus) which undergo small incision ECCE. Both groups insert a posterior chamber PMMA intraocular lens under operation.SURGICAL PROCEDURES:PhacoemulsificationA 5 . 5 -6.0 mm frown sclera tunnel incision was created in 12:00 upper position. The AC was maintained with sodium chondroit-in4. 0 % and sodium hyaluronate 3 . 0 % ( Viscoat, Alcon ) . A5. 0 -6. 0 mm circular continuous capsulorhexis was performed. After hydro-dissection a phacoemulsification tip was used to remove the lens nucle-us(phaco chop technique) ;residual cortical material was removed by automatic irrigation and aspiration system. When cortical aspiration was complete, the incision was enlarged to 5.5 - 6 mm. A 5. 5 mm PMMA posterior chamber IOL was placed in the capsular bag. The viscoelastic was aspirated and the incision was closed with a single radial stitch.Small incision ECCEAfter hydrodissection and hydrodelineation were performed, the nucleus was moved into the AC by injecting a viscoelastic between the nucleus and the epinucleus. Nucleus capture was performed after the tunnel was enlarged to 5.5 -6.0 mm using a bimanual manoeuvre i$ which a spoon was introduced under the nucleus and a forceps was used to stabilize eyeball. The nucleus was then extracted through the tunnel. Other operation were as same as phacoemulsification.All operation were accomplished by a single surgeon. All patients received topical tobramycin and dexamethasone eye drops were prescribed five times daily for 2 weeks and three times daily for an additional 7 days . Follow - up was 3 months at least. Measured outcomes included uncorrected and best corrected visual acuity, astigmatism, intraoperative and postoperative complications, and operative time. Vision , astigmatism were measured and recorded in all patients for 1 day before the operation and at 1 day , 1 week, 2 weeks, 1 and 3 months postoperatively.Statistical analysis: t - test was used to evaluate internal variations and to compare data from two groups before surgery and at 1 day, 1 week, 2 weeks, 1 month and 3 months postoperatively.RESULTS60 patients (36 women) aged 55 -78 years underwent a follow up examination 3 months postoperatively (Table 1 ). All patients completed the study. Our results showed that vision and astigmatism differences at 1 day, 1 week, 2 weeks, 1 and 3 months postoperatively were not statistically significant ( p > 0. 05 ) with two surgical techniques ( Table 2 ) . Mean operative time in two groups was 20.23 4.17min and 19. 50 3. 93min, respectively. No significant difference was seen between two groups (P >0.05). Complications in group IIinclude hyphema (2 eyes, 6. 67% ) and anterior capsular rupture (4eyes, 13.33 % ) , group I include corneal edema ( 4eyes ,13.33%) and posterior capsular rupture (2eyes, 6.67% ). No severe complications were found in two groups.DISCUSSIONAlthough some surgeons considered that small incision ECCE can achieve a similar outcome like phaco, most surgeons currently considered that smaller incision may increase difficulty of the mannul extra-capsular surgery, and need skillful surgical technique, the safety of the small incision ECCE should be discussed.In this study,on the different stage after surgery, no significant differences in postoperative vision and astigmatism were found between the two groups. On the end of 3 months follow - up, by vector analysis, the mean surgically induced astigmatism was 0.73 0.39D and 0.72 0.30D in the phacoemulsification and the small incision ECCEgroup, res... |
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