Efficacy Observation Between Phacoemulsification And Small Incision Cataract Surgery In Hard Nucleus Cataract After Trabeculectomy

Objective:By comparing the clinical efficacy between phacoemulsification(PHACO)and small incision cataract surgery(SICS),this paper can provide some references for the surgical treatment of patients with hard nucleus cataract after trabeculectomy.Methods:In this retrospective controlled study,the 45 patients(45 eyes)with hard nucleus cataracts after trabeculectomy at the Second Hospital of Jilin University from January 2018 to September 2019,were recorded and divided into two groups.PHACO group included 23 patients(23 eyes)performed by phacoemulsification.SICS group included 22 patients(22 eyes)performed by small incision cataract surgery.Through these patients,the intraocular pressure,the best corrected visual acuity(BCVA),corneal astigmatism,corneal endothelial cell loss rate and complications were observed.Results:1.The intraocular pressure:The preoperative intraocular pressure of PHACO group and SICS group were(18.38±1.76)mmHg and(18.13±1.96)mmHg,respectively.The intraocular pressure at postoperative 1 week,1 month and 3 months were(14.06 ± 1.39)mmHg,(12.94 ± 1.12)mmHg,and(12.69 ± 1.01)mmHg of PHACO group,respectively.They were(13.47 ± 1.25)mmHg,(12.60 ± 1.55)mmHg,and(12.13 ± 0.83)mmHg of SICS group,respectively.The differences were significant between preoperative and every postoperative stage of each group(P<0.05).However,there was no difference of the intraocular pressure between two groups at any stages(P>0.05).2.The best corrected visual acuity(BCVA): The BCVA at any postoperative stages increased with different values in both groups.However there was a statistically significant difference in the number of postoperative visual acuity improvements between the two groups(P<0.05).The overall visual acuity improvement of PHACO group was better than that of SICS group.3.Corneal astigmatism: The astigmatism at postoperative 1 week,1 month,and 3 months increased by(0.42±0.39)D,(0.15±0.34)D and(0.08±0.44)D of PHACO group compared with preoperative,respectively.They were(2.06±0.54)D,(1.81±0.53)D and(1.68±0.46)D of SICS group,respectively.There were statistical differences in astigmatism changes between two groups at any stages after surgery(P<0.05).4.The loss of corneal endothelial cells:The rates of corneal endothelial cell loss of PHACO group and SICS group at postoperative 3 months were(16.1 ± 5.14)% and(11.3 ± 1.72)%,respectively.Compared with SICS group,the corneal endothelial cell density was lower in the PHACO group,and the reduction was higher,whose differences were statistical(P <0.05).5.Complication: The serious complications,such as posterior capsule rupture,retinal detachment,and suprachoroidal hemorrhage did not occur in operation and after operation.Conclusion:1.Both PHACO and SICS had good effects on short-term intraocular pressure control of patients with hard nucleus cataract after trabeculectomy.2.Due to the presence of sutures in SICS group,PHACO was superior to SICS in terms of visual acuity recovery and the effects of astigmatism.3.The loss of corneal endothelial cells in SICS group was less than PHACO in patients with hard nucleus cataract after trabeculectomy.4.For patients with a satisfactory corneal endothelial cell count,experienced physicians can still use PHACO as an optimal choice for patients with hard nuclear cataract after trabeculectomy.However for patients with low corneal endothelial cell counts or clinicians who are not good at PHACO technology,it is necessary to choose the best surgical operation by counterpoising the advantages and disadvantages according to their own conditions.5.If eye conditions are acceptable,surgical operation is recommended when the nucleus hardness of cataract after anti-glaucoma surgeries is grade II or III.