The Clinical Study Of MSICS And Phacoemulsification For Cataract With Axial High Mypia

Objective: To evaluate and compare the surgical outcomes ofMSICS and phacoemulsification in cataract with axial high myopia.Methods:176cases(198eyes) cataract patients whose axial length≥26mm,88cases（101eyes）, were divided into three groups (group A1:32cases33eyes, group B1:31cases36eyes，group C1：25cases32eyes),≥22mm,≤24mm,88cases(97eyes)whose axial length, were divided into three groups (group A2:34cases36eyes, group B2:35cases37eyes, group C2:19cases26eyes).Thepatients in group A1and group A2underwent MSICS (Cracking-phaco).Thepatients in group B1and group B2underwent ultrasonic phacoemulsification.The patients in group C1and group C2underwent MSICS(Chopping-extraction).All the patients were implanted in low-diopter intraocular lens.The BCVA, as--tigmatism,IOP, counts of corneal endothelial cells,ocular axis length,and theincidence of complications were measured on a day before and after operation,on a week after operation,on three month after surgery. The statistical analysiswere applied with SPSS19.0, including independent samples T test, varianceanalysis,LSD method and pearson correlation analysis. statistically significant(P<0.05),r<0.300to no correlation,r=0.300～0.499for low correlation, r=0.500～0.800for moderate correlation,r>0.800highly relevant.Results:1.Postoperative and preoperative,group A1,group B1,group A2, groupB2, group C1, group C2were different in vision,(F=5.247, P=0.003<0.05); The preoperative visual acuity of group A1and group B1, had no significantdifference (P>0.05),the two groups’ vision were better than group C1(P<0.05);The group A1and group B1had better vision than group C1after a daypostoperative(P<0.05). The three groups’ vision had no significant differenceafter3days, after a week, after a month,after3months postoperative (P>0.05).The preoperative visual acuity of group A2and group B2, were similar(P>0.05),the two groups’ vision were better than group C2(P<0.05); The groupA2and group B2had better vision than group C2after a daypostoperation(P<0.05). The three groups’ vision had no significant differenceafter3days, after1week, after1month,after3months postoperative(P>0.05).Age-related cataract groups’(group A2, group B2,group C2)preoperative and postoperative visual acuity were better than group A1, groupB1,group C1(P<0.05)2.Comparison of postoperative corneal endothelial cellloss amount,the six groups of corneal endothelial cell loss had significantdifference (P<0.05);Group A1and group B1had no significant difference(P>0.05); The difference between group A1and group A2was statisticallysignificant (P<0.05);Between group A1and group C1,the difference wasstatistically significant (P<0.05);The loss of group B1and group B2, weredifferent (P>0.05);The loss endothelial difference between group A2andgroup B2had no difference(P>0.05); The endothelial loss difference ofgroup A2was less than group C2(P<0.05);3.Postoperative intraocularpressure fluctuations of the six groups (group A1, group B1, group A2, group B2, group C1，group C2) were statistically different (P<0.05);On a day,3days,aweek,after operation,intraocular pressure fluctuations of group A1,group B1and group C1had statistical difference (P<0.05),postoperative a month,3months, the three groups of intraocular pressure fluctuation had no statisticaldifference(P>0.05); The fluctuations had less change postoperative a month inthe three groups(P>0.05); On a day,3days,a week,a month,3months afteroperation,the intraocular pressure fluctuations of group A2,group B2were nosignificant differences (P>0.05); In group A1,group B1and group C1,postoperative a month, the intraocular pressure fluctuations were not statisticaldifference (P>0.05); The intraocular pressure fluctuations of group A2,groupB2had statistical difference (P<0.05), the two groups(group A2and group C2)of intraocular pressure fluctuation had difference (P＜0.05);Intraocularpressure fluctuations in group A2,group B2and group C2were stable inpostoperative a week (P>0.05).4Postoperative axial length of group A1, groupB1,groupA2,groupB2and group C2was shorter than the average preoperativeaxial length, but they were no statistically significantdifferences(P>0.05);Postoperative and preoperative axial length of group C1was statistically significantly different(P＜0.05); Comparing in the sixgroups(group A1, group B1, group A2, group B2, group C1, group C2), theaxisal measurement errors had significant differences(P<0.05);The error of thegroup A1and group B1was smaller than group C1(P<0.05);The error of thegroup A2and group B2was smaller than group C2(P<0.05);5.In the group A1, group B1and group C1,the preoperative diopter was larger than thepostoperative diopter, the difference was statistically significant(P>0.05);In thegroup A2, B2and C2,the expected diopter and actual diopter weresimilar(P>0.05);The error of group A1, B1and C1was more significant thanthe error of group A2, B2and C2;Compared group A1and group B1,the errorwas similar(P>0.05);The different of group A1and group C1in diopter wasstatistically significant(P<0.05); Compared group A2and group B2,the errorwas similar(P>0.05);The different of group A2and group C2in diopter wasstatistically significant(P<0.05);6.In group A1,group B1and group C1,theerror of diopter was associated with ocular axial length and the measurementerror of diopter (r＞0.300);and as the growth of the eye axis, the relevance wasincreasing; In the simple cataract group(group A2,group B2and group C2), theerror of the diopter and eye axis had no correlation (r<0.3).7.Comparedpreoperative and postoperative corneal astigmatism of the six groups(group A1,group B1, group C1, group A2, group B2,group C2), there was no significantdifference(P>0.05); group A1, preoperative and on a day,3days,a month,3months after operation,the differences had statistical significance(P=0.00<0.05), preoperative astigmatism and astigmatism in a week afteroperation had no significant difference (P=0.356>0.05); Group B1,group C1,group A2, group B2,and group C2got the similar results: the preoperativeastigmatism and astigmatism on1day,3days,1month,3months after thesurgery,were different (P <0.05), preoperative astigmatism and astigmatism in a week after surgery,had no statistically difference, preoperative andpostoperative corneal astigmatism, no statistically difference, no statisticalsignificance (P>0.05). Preoperative corneal astigmatism of the sixgroups(group A1, group B1, group C1,group A2, group B2,and group C2),werepriority to the inverse astigmatism and on a day,3days,1week after thesurgery,the with-the-rule astigmatism was increasing,the inverse rulesastigmatism after a months,3months later, the proportion of the inverseastigmatism was more than preoperative. The constituent ratio of preoperativeand postoperative corneal astigmatism axis, had no statistical difference.8.Postoperative a day,3days, a week, a month,3months, the SIA of the groupA1, group B1, group A2, group B2, group C1and group C2, had nostatistically difference (P>0.05); The six groups of SIA, postoperative SIA hada difference from a day to a month after surgery (P <0.05), postoperative amonth and3months postoperatively SIA was similar (P>0.05); In groupA1,the postoperative SIA tended to be stable in3months; The groupA2,groupB2, groupC1and group C2got the similar results with group A1.Conclusion:1. The postoperative visual acuity, intraocular pressure,astigmatism compared small incision with ball conjunctiva cataractextractiontechnique(Cracking-phaco) with phacoemulsification was nosignificant difference, and their postoperative effect was similar, but the formeroperation controllability was controllability, not easy to appear seriouscomplications, little injury to Ocular surface. It was a better surgical choice for cataract patients withⅠ~Ⅲ level nuclear.2.For the cataract patients with Ⅳ, Ⅴnuclear,the small incision with ball conjunctiva cataract chopping nucleusexcision, had postoperative visual acuity, small astigmatism, less postoperativecomplications.3. For the high myopia patients with the hardness nuclear,theoperation was more difficult, the postoperative corneal endothelial injury washeavier, and postoperative intraocular pressure fluctuations was more obvious.So you can suggested the patients with an early surgery, to reduce the risk ofoperation and improve the postoperative effect.4. Eye axis measurementaccurate or not directly affect the visual quality of cataract patients aftersurgery.Only improving the accuracy of axial length measurement can reducedioptre error of postoperative patients,and obtain the higher visual quality.