Study of Healing and Effects on Corneal Astigmatism of Clear Corneal Incisions after Phacoemulsification
|School||Shandong University of Traditional Chinese Medicine|
|Keywords||Age-related cataract clear corneal incision healing astigmatism|
Objective: Application of anterior segment optical coherence tomography (Anteriorsegment optical coherence tomography, AS-OCT) and anterior segment analysis system(Pentacam) transparent corneal incision in phacoemulsification with different size andrange of healing and to study the effect of the postoperative astigmatism.Methods: This study selected age-related cataract phacoemulsification and foldableintraocular lens implantation in104patients (120eyes), there were46male and58femalepatients, with an average age of67.35, Ⅱ~Ⅲ nuclear. Application of AS-OCT andPentacam respectively at1day before operation on postoperative eye scanning. Accordingto the artificial crystal were selected according to the type of corneal incision size, dividedinto2.2mm incision group (A group) and3.0mm incision group (group B); according tothe cut direction, and the2group was divided into two subgroups, incision at the top of the(70°-110°) for A1and B1, incision in the temporal side (0°-30°/150°-180°) for A2and B2. On the first preoperative day, and the first postoperative day,week,2weeks,1monthapplication of OCT and Pentacam1month on postoperative corneal incision and cornealcurvature were examined.Data were analyzed by SPSS17.0statistical software, variance analysis of quantitativedata using one-way analysis of variance and two factors of repeated measurements.Qualitative data were performed by a list of chi-square test, four groups statisticallysignificant by chi-square divided two two comparison, according to the formula of P ’=(2*a)/[k*(k-1)1](a for the original inspection level, K component) rectifying inspectionstandards with P <0.0083as significant differences.Results:(1)This study includeing50cases of A patients (54eyes), including male23cases, female27cases;54cases of B patients (66eyes), including23males and31femalepatients, two groups of gender comparison (P=0.844) showed no significant difference between gender, the subgroups compared no significant difference (P=0.926)(2) The release of the energy accumulated during the two groups (cumulativedissipated energy, CDE) compared with A group was3.58±0.26, B was3.57±0.19, withno significant difference between two groups (P=0.324), each subgroup CDE (P=0.276)had no significant difference.The use of two groups of perfusion fluid in A group was (37.83±0.35) V/ml, B group(37.75±0.81) V/ml, with no significant difference between two groups (P=0.334), nosignificant difference in the two groups (P=0.226) perfusion fluid.(3) On the first preoperative day the IOP in A group was (16.32±1.21) mmHg, Bgroup (16.03±0.98) mmHg, the two groups had no significant difference (P=0.433); thefist postoperative day,1week,2weeks and1month respectively in A group was (15.07±0.98intraocular pressure) mmHg,(14.35±0.68) mmHg,(14.37±0.68) mmHg,(13.94±0.78) mmHg, B group (15.23±1.22) intraocular pressure is mmHg,(14.66±0.88) mmHg,(14.20±0.98) mmHg,(13.89±0.68) mmHg, the difference was not statistically significant(P=0.568,0.667,0.897,0.789); various subgroups with no statistical significance (P=0.260,0.255,0.342,0.433).(4)The postoperative corneal thickness of1days of incision of the added value of Agroup was (0.36±0.86) mm, B group (0.25±0.75) The A group corneal thicknessincreased with statistical significance than the B group (P=0.026), and the differencewithin group comparison above incision corneal thickness increased value than thetemporal group and the difference was statistically significant (P=0.034); after1weeks, thecorneal thickness increased value of A group was (0.12±0.73) mm, B group (0.16±0.78)mm, B group1weeks after operation, corneal thickness increase was statisticallysignificant value and the difference between the two groups (P=0.034), over the incision.Significance values and differences than temporal incision corneal thickness increased(P=0.046); after two groups of corneal thickness in2weeks after operation and the addedvalue in January was A group (0.06±0.63) mm,(0.03±0.45) mm, B group (0.14±0.66)mm,(0.03±0.56) mm, no significant difference (P=0.688,0.768), each subgroupcomparisons between groups had no significant difference (P=0.887,0.909).(5)The first postoperative the incision of the corneal thickness of A group (1.21±0.87)mm, B group (1.13±0.66) mm have significant difference (P=0.046), and group incisioncorneal thickness comparison above were statistically significant (P=0.034,0.025); theposttopertuive1week in group A (0.89±0.69) mm, B group (0.95±0.78) mm have significant difference (P=0.047), and group incision corneal thickness comparison abovewere statistically significant (P=0.047,0.038); for2weeks,1month and the cornealthickness after operation in A group (0.80±0.77) mm,(0.77±0.68) mm, B group (0.86±0.78) mm,(0.78±0.89) there was no significant difference of mm (P=0.466,0.679), eachsubgroup comparisons between groups had no significant difference (P=0.898,0.809).(6)two group,7mm curvature on postoperative day1Changes of2.2mm group3.0mm group(P <0.05); the postoperative1week and2weeks in group2.2mm than3.0mm suite ratechanges slightly larger (P <0.05), the two group than the above temporal changes (P＜0.05); postoperative1month two group curvature than the preoperative decreases andtends to be consistent (P>0.05).(6) Two groups of incision corneal thickness returned to the preoperative conditionratio the postoperative1week was25.92%in A group,7.57%in B group, the differencewas statistically significant (P=0.006), two groups of inner temporal than above theextinction ratio of no significant difference (P=0.185,0.176and2weeks after operation);the A group was40.74%,33.33%in B group, no significant difference (P=0.449), subnostatistical significance between the two groups (P=0.056); in January two groups allsubsided to the preoperative.(7) The incision configuration analysis: postoperative day incision inside the mouthopen rate of A group was53.70%,30.30%in B group had significant difference (P=0.015),no significant difference among groups (P=0.069); the postoperative1week was16.66%in A group, B group was34.84%and the difference is statistical significance (P=0.037),incision group above the mouth open incidence than temporal high and the difference wasstatistically significant (P=0.002,0.003); the postoperative2weeks incision open rate of Agroup was11.11%,13.63%in B group showed no significant difference (P=0.785),without statistical significance in each subgroup comparison between (P=0.845)The first postopertive day,1week,2weeks after the elastic layer from the A groupwas22.22%,12.96%,7.40%,27.27%,19.69%,10.60%in group B, there was nosignificant difference between the two groups (P=0.897,0.886,0.785), but no significantdifference within groups.(8) Two groups preoperative curvature group A incision was43.36±1.22, B was43.57±1.36, no significant difference (P=0.875); The first postopertive day in group Awas42.44±1.24, B was41.36±0.98, and the difference is statistically significant(P=0.045), change the upper incision curvature group were statistically significant than temporal incision small differences (P=0.023,0.035);41.96±0.84, B group was42.75±0.98to the postopertive1week, A group, and the difference is statistically significant(P=0.243), were compared with statistical significance than the above changes in temporalside small curvature difference (P=0.046,0.067); the postoperative2weeks, andpostoperative incision curvature January between two groups A group was42.48±0.88,42.73±0.98, B group42.23±0.94,42.83±1,23than preoperative decreases and tends tobe consistent (P=0.236,0.365), each subgroup of no statistical differences (P=0.157,0.120).(9) the postopertive1week and1month two groups of UCVA, BCVA respectively, Agroup4.56±0.98,4.83±1.23, B4.43±1.22,4.86±1.09, no significant differencesbetween the two groups (P=0.876,0.856), each subgroup of no statistical differences(P=0.579,0.658); the postopertive1week A group (1.27±1.45) D, B group (1.51±0.98)D, B group than in the A group spherical slightly larger but the difference was notstatistically significant (P=0.886). In January the spherical A group (0.57±0.66) D,(0.68±0.97) D, there was no statistically significant difference.Conclusions: This study found that2.2mm clear corneal incision the postopertive1wee, inside the mouth open change rate, incision corneal curvature is3.0mm above theincision, the postopertive1week, inside the mouth open change rate, incision cornealcurvature than the temporal incision large; but in the healing process of corneal edema,inside the mouth duo change rate of incision configuration analysis and incision cornealcurvature, significantly better than the3.0mm clear corneal incision1weeks2.2mm clearcorneal incision healing, and temporal healing is obviously better than the above; thepostopertive2weeks, healing tend to be consistent, but the incision corneal thickness thanpreoperative increased slightly; after January two groups besides above3.0mm group1cases of malunion, and all the other good healing.The postopertive1weeks,1month two groups of UCVA, BCVA had no significantdifference in groups, is also no significant difference; the postopertive1weeks, thelenticular degree in3.0mm group than in the2.2mm group slightly larger, cornealastigmatism group2.2mm slightly small; temporal incision is better than the above UCVAincision, cylindrical diopter temporal incision group better than the superior incision groupthe temporal incision corneal astigmatism is small; for based on the preoperative cornealcurvature maximum curvature of warp direction for the selection of corneal incisionposition so the postoperative corneal wound healing after January good cylindrical diopter had no significant difference, the postoperative corneal astigmatism than preoperativesmall.