| Objective: To observe and analyse the changes of cornealmorphology and the clinical significance after phacoemulsification through1.8mm and2.8mm clear corneal tunnel incision and manualnucleofragmentation emulsification through2.8mm corneosclera tunnelincision. Methods: Totally120eyes of86patients with age-related cataract(levelⅠ~Ⅲ) were divided into three groups according to the operation methods.40eyes of31patients in group A underwent phacoemulsification through1.8mm coaxial clear corneal incision and artificial lens implantation.40eyes of28patients in group B underwent phacoemulsification through2.8mm coaxialclear corneal incision and artificial lens implantation.40eyes of27patients ingroup C underwent manual nucleofragmentation emulsification through2.8mmcorneosclera tunnel incision and artificial lens implantation. Visual acuity ofnaked eyes was recorded in1day,1week,1month and3month. The changesof corneal morphology in the incision and corneal volume were observed byAS-OCT and Pentacam in6hour,24hour,48hour,72hour,1week,1monthand3month after surgery. The changes of corneal curvature were recorded in24hour,1week,1month and3month after surgery and worked out surgicallyinduced astigmatism (SIA) by Jaffe/Clayman vector method. The cornealendothelial density was detected and calculated the endothelial cell loss.Results:1. There was significant statistical difference in visual acuity of naked eyes between the3groups at1day and1week after the operation(P<0.05).Group A showed better uncorrected visual acuity than group B and group C(P<0.05), and group C showed better uncorrected visual acuity than group B(P<0.05). There was no significant statistical difference in visual acuity ofnaked eyes between the3groups at1month and3months after the operation(P>0.05).2. There was significant statistical difference in surgically inducedastigmatism between the3groups at one day,1week,1month and3monthsafter the operation(P<0.05). There were significant statistical differences insurgically induced astigmatism between group A and group B, group A andgroup C, group B and group C at all time points (P<0.05), and the surgicallyinduced astigmatism of group A was lowest, and that of group B was highest.3.There was no significant statistical difference in corneal volume between the3groups at the pre-operation (P>0.05), but the difference was statisticallysignificant at6hours,24hours,48hours,72hours after the operation(P<0.05),and there was no significant statistical difference in corneal volume between the3groups at1week,1month,3months after the operation (P>0.05).6hoursafter the surgery, the difference was statistically significant between group Aand group B, group B and group C in corneal volume (P<0.05), but nostatistically significant between group A and group C (P>0.05).24hours,48hours and72hours after the surgery, the difference was statistically significantbetween group A and group C, group B and group C in corneal volume(P<0.05), but no statistically significant between group A and group B (P>0.05). 4. There was no significant statistical difference in corneal endothelial celldensity between the3groups at pre-operation and3months of postoperation(P>0.05), but there was significant statistical difference in endothelial cell lossbetween the3groups (P<0.05). The difference was statistically significantbetween group A and group C, group B and group C (P<0.05), but nostatistically significant between group A and group B (P>0.05), and theendothelial cell loss of group C was lower than that of group A and group B(P<0.05).5. There were significant statistical differences in endothelial gapingbetween the3groups at each point in time within one month (P<0.05). Theincidence of endothelial gaping was highest within6hours after surgery (58%,group A;85%, group B;65%, group C). As time passed, endothelial gapinggradually reduced, and the sealing of endothelial side of the wound was well at3months after surgery. The difference was statistically significant betweengroup A and group B within48hours after surgery (P<0.05), but no statisticallysignificant after72hours (P>0.05). There was no significant statisticaldifference between group A and group C at all point in time (P>0.05). Thedifference was statistically significant between group B and group C at24hours,1week and1month after surgery (P<0.05), but no statisticallysignificant at6hours,48hours and72hours after surgery (P>0.05).6. Therewas significant statistical differences in the incidence of Descemet flap betweenthe3groups at each point in time within one week (P<0.05). The incidence ofDescemet flap was highest at6hours after surgery (68%, group A;63%, group B;33%, group C), and all patients achieved union at1month after surgery. Thedifference was no statistically significant between group A and group B at6hours after surgery (P>0.05), but the difference was statistically significantafter24hours (P<0.05). The difference was statistically significant betweengroup A and group C at6hours after surgery (P<0.05), but no statisticallysignificant after24hours (P>0.05). The difference was statistically significantbetween group B and group C at6hours,24hours and48hours after surgery(P<0.05), but no statistically significant at72hours and1week after surgery(P>0.05).7. The difference was statistically significant in corneal thickness ofthe incision between3groups at each point in time within3months aftersurgery (P<0.05), but no statistically significant at3months after surgery(P>0.05).6hours,24hours,48hours,72hours and1week after surgery, therewas significant statistical differences in corneal thickness of the incisionbetween the each groups (P<0.05); thickness of group B was the largest andthickness of group C was the minimum. The difference was statisticallysignificant between group A and group B, group B and group C at1month aftersurgery (P<0.05), but no statistically significant between group A and group C(P>0.05); Thickness of group B was higher than that of group A and group C.Conclusion:1. All three surgical techniques induced the slight changes ofcorneal morphology. The change of corneal morphology was minimal by1.8mm clear corneal tunnel incision phacoemulsification, and was the biggestof three surgical techniques by2.8mm clear corneal tunnel incision phacoemulsification, and was somewhere in the middle by2.8mm corneoscleratunnel incision manual nucleofragmentation emulsification.2. All three surgicaltechniques induced mild and clinically insignificant gaping of the incision’sendothelial edge, Descemet’s flap and stromal edema of wound. The change inthe form of incision by phacoemulsification was greater than that by manualnucleofragmentation emulsification.3. Phacoemulsification through1.8mmcoaxial microincision can rapidly restore the early visual acuity. The manualnucleofragmentation emulsification through2.8mm corneosclera tunnelincision can cause lower endothelial cell loss. The cataract extraction surgerythrough high perfusion and aspiration after water emulsification is more concise.We can choose different surgical techniques depending on the clinical situation. |
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