Application Of Microincision Cataract Surgery Platform In Ophthalmic Disease

Objective:To compare the outcomes of the microincision cataract surgery (1.8mm) andmini-incision coaxial phacoemulsification (2.8mm) on the postoperative visual acuity,corneal astigmatism, corneal endothelial cells and intraoperative ultrasound energy; and toevaluate the complications and visual acuity outcomes in the combined cataract surgeryand vitrectomy for diabetic retinopathy with micro-incision coaxial phacoemulsification(2.2mm): A single-surgeon Study.Patients and Methods:Part IFrom March2012to September2012, Patients with age-related cataract (n=37eyes)were divided into2groups,17cases with1.8mm clear corneal incision and implantationof IOL (HOYA, NY-60), and20cases with2.8mm clear corneal incision and implantation of IOL (Bausch&Lomb, ADAPT-AO). The vision acuity (detected by standard visualacuity chart), corneal endothelial count (evaluated by using corneal topography),intraocular pressure, anterior chamber cells, A/B Scan, optical coherence tomography,IOL-Master, were acquired preoperatively and postoperatively. The effectivephacoemulsification time, average power time and U/S%were recorded during theoperation.Part ⅡFrom January2011to October2012, consecutive observation was done to59patientswith diabetic retinopathy (n=59,59eyes) undergoing vitrectomy along with cataractphacoemulsification. The serum glucose level was controlled satisfactorily. Patients weredivided into two groups according to different corneal incision (2.2mm,3.0mm)phacoemulsification. The all clinical data including patients information, cataract grading,extent of retinopathy, visual acuity, posterior capsular condition, anterior chamber depthand complications such as anterior chamber reaction, synechiae, hemorrhage, intraocularpressure were evaluated preoperatively and postoperatively.Results:1.1Vision: There were no significant differences on postoperative visual acuity betweenthe two groups on1day,1week and1month after surgery (P>0.05) respectively.1.2Anterior chamber cells: There were no significant differences on postoperativeinflammatory cells in the anterior chamber between the two groups on1day after surgery(P>0.05) respectively.1.3Intraocular pressure: There was no statistically significant between two groups at1day,1week and1month postoperatively (P>0.05).1.4Corneal astigmatism: Corneal astigmatisms were increased after surgery in bothincision groups. Compared with the preoperative group, there was no statisticallysignificant (P>0.05) of corneal astigmatism in the group of1.8mm incision on1day,1week and1month after operation. In the2.8mm group, statistically significant of corneal astigmatism was observed between preoperative group and1day postoperative group (P<0.05), but no statistically significant was observed between preoperative group and1week postoperative group.1.5Surgically induced astigmatism (SIA): SIA calculation was performed with the methodof vector analysis. There was no statistically significant between two groups at1day,1week postoperatively. At1month postoperatively observation, SIA was (0.36±0.31) Dand (0.61±0.36) D (P <0.05) in the1.8mm group and the2.8mm group, respectively.1.6Postoperative corneal endothelial cell: There were no obvious differences ofendothelial cells in the two groups between1week and1month after cataract surgery (P>0.05). In the group of2.8mm, the statistically significant differences (P <0.001) wereobserved in corneal endothelial cell density between preoperative and postoperative1week,1month, respectively.1.7Ultrasonic power: No statistically significant differences were found intraoperative ineither of the groups (P>0.05). APT and EPT were longer in the1.8mm group than in the2.8mm group. The correlation analysis between the hardness of cataract and EPT ofrelevant showed that the nuclear hardness and EPT were positively correlated (r=0.429, P=0.008).2.1There were no significant differences on postoperative visual acuity between twogroups (P>0.05), In the postoperative mini-incision coaxial phacoemulsification groups,visual acuity increased more than two lines for18cases (62.1%), and correction in twolines for8cases (27.6%), whereas decreased in3cases (10.3%); microincision group:Postoperative visual acuity improved more than two lines of20cases (66.7%), with twolines in6cases (20.0%), and decreased in4cases (13.3%).2.2There were no significant differences on postoperative complications between twogroups (P>0.05). Postoperative complications in the mini-incision coaxialphacoemulsification group including; fibrinous eudation (n=9,31.0%), macular edema(n=3,10.3%), posterior synechiae (n=6,20.7%), vitreous hemorrhage (n=1,3.4%), intraocular pressure (n=1,3.4%), retinal detachment (n=1,3.4%), posterior capsularopacification (n=1,3.4%), and corneal incision leakage (n=4,13.8%); On the contrast, inthe group of microincision were fibrinoid exudation (n=5,16.7%), macular edema (n=3,10.0%), posterior synechiae (n=3,10.0%), vitreous hemorrhage (n=1,3.3%), intraocularpressure (n=2,6.7%), retinal detachment (n=1,3.3%), and posterior capsular opacification(n=1,3.3%).Conclusions: Microincision cataract surgery could get faster visual rehabilitation, lessnegative effects on corneal astigmatism and corneal endothelial cell density. The coaxial1.8mm microincision can reduce a modification of the surgically induced astigmatism.Although long-term effects had little difference between two groups, microincisioncataract surgery operation platform has a broad prospect and application of combinedoperations. Phacoemulsification combined with vitrectomy was found to be safe andeffective, Microincision cataract surgery combining with vitrectomy can maintain anteriorchamber depth, anterior chamber reaction and leakage of incision are less after operation;Combined surgery avoids repeated surgery and reduces the treatment fees again.