Effect of hypothermic perfusion on phacoemulsification in eyes with hard nuclear cataract: randomized trial
Effect of hypothermic perfusion on phacoemulsification in eyes with hard nuclear cataract: randomized trial
复制标题
低温灌注对硬核性白内障眼超声乳化术的影响：随机试验
DOI：
10.1016/j.jcrs.2019.07.029
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发表时间：
2019
影响因子：
2.8
通讯作者：
Ke Hu
中科院分区：
文献类型：
--
作者：
wenjuan wan;Lu Jiang;Yan Ji;Yan Xun;Liang Xiong;Yongguo Xiang;Ruonan Li;Zhouyu Li;Xiaoqin Wang;Jay M. Stewart;Ke Hu
目的评价低温灌注在硬核白内障超声乳化术中的有效性和安全性，研究单位：中国第三眼科中心，设计实验室研究和前瞻性随机临床试验。观察兔手术前、术后1天、7天的眼前节光学相干断层扫描（AS-OCT）、角膜内皮细胞计数（ECC）和角膜切片。分别于术前、术后1 d、7 d、30 d观察AS-OCT、角膜ECC、前房炎症反应。在动物模型中，术后第1天，4°C组的平均中央角膜厚度（CCT）（370.4 μm ± 45.5 [SD]）比24°C组（496.7 ± 121.5 μm）薄（P< .001）。4°C组的平均AC炎症反应等级（1.1 ± 0.9）低于24°C组（2.2 ± 0.8）（P= 0.0333）。在临床试验中，4°C组的平均CCT和切口角膜厚度（分别为600.7 ± 51.8 μm和859.2 ± 177.8 μm）薄于24°C组（分别为655.3 ± 85.0 μm和955.9 ± 196.7 μm）（P< .001）。4°C组的内皮细胞密度（P= 0.036）和六边形（P= 0.001）较高。4°C组术后第1天AC炎症反应平均分级（0.6 ± 0.6）低于24°C组（1.3 ± 1.0）（P= 0.004）。结论硬核白内障超声乳化术中低温灌注安全，能有效保护角膜内皮，减轻角膜水肿，减少术后早期AC炎症反应。
PurposeTo evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of hard nuclear cataract.SettingTertiary opthalmology center, China.DesignLaboratory study and prospective randomized clinical trial.MethodsRabbits and patients with hard nuclear cataract underwent phacoemulsification with perfusion temperatures at 4°C or 24°C. Anterior segment optical coherence tomography (AS-OCT), corneal endothelial cell count (ECC), and cornea sections were observed before the rabbits' operation and 1 day and 7 days postoperatively. AS-OCT, corneal ECC, and anterior chamber (AC) inflammation were observed before the patients' operation and 1 day, 7 days, and 30 days postoperatively.ResultsThe study comprised 40 rabbits and 80 patients. In the animal models, the mean central corneal thickness (CCT) in the 4°C group (370.4 μm ± 45.5 [SD]) was thinner than in the 24°C group (496.7 ± 121.5 μm) 1 day postoperatively (P< .001). The mean AC inflammation reaction grade in the 4°C group (1.1 ± 0.9) was lower than in the 24°C group (2.2 ± 0.8) (P= .0333). In clinical trials, the mean CCT and incisional corneal thicknesses in the 4°C group (600.7 ± 51.8 μm and 859.2 ± 177.8 μm, respectively) were thinner than in the 24°C group (655.3 ± 85.0 μm and 955.9 ± 196.7 μm, respectively) (P< .001). The endothelial cell density (P= .036) and hexagonality (P= .001) were higher in the 4°C group. The mean AC inflammation reaction grade in the 4°C group (0.6 ± 0.6) was lower than in the 24°C group (1.3 ± 1.0) 1 day postoperatively (P= .004).ConclusionsHypothermic perfusion in phacoemulsification of hard nuclear cataract is safe and it can effectively protect corneal endothelium, decrease corneal edema, and reduce AC inflammation in the early postoperative stage.