| Objective:To evaluate the safety of cataract phacoemulsification with arched corneal incision.Methods:prospective controlled study.Age-related cataract patients(143cases,160 eyes)who met the inclusion criteria from June 2020 to December 2020were divided into soft nucleus group(118 cases,134 eyes)and hard nucleus group(25 cases,26 eyes)according to the Emery–Little system classification system.Then they were divided into arched corneal incision group and stepped plane corneal incision group according to the shape of the corneal incision.Phacoemulsification cataract aspiration combined with intraocular lens implantation was performed.Only the shape of the main corneal incision was different during the operation,and the other procedures were the same.The operation was performed by two experienced surgeons.The changes of anterior chamber depth during operation,corneal incision leakage after operation,postoperative corneal astigmatism,corneal endothelial cell count and intraoperative and postoperative complications were recorded.Results:1.Anterior chamber stability during surgery:in the soft nucleus cataract group,when pull out phaco needles,first pull out infusion/aspiration needle(I/A)and second time pull out I/A needle,the total score of anterior chamber changes in the arched corneal incision group was 113,while the stepped plane corneal incisiongroup was 186 points,the difference between the two groups was statistically significant(Z=4.366,P=0.000).In the hard nucleus cataract group,when pull out phaco needles,first pull out infusion/aspiration needle(I/A)and second time pull out I/A needle,the total score of anterior chamber changes in the arched corneal incision group was 27,while the stepped plane corneal incision group was 39 points,the difference between the two groups was statistically significant(Z=-6.715,P=0.000).In all cataracts,when pull ou phaco needles,first pull out infusion/aspiration needle(I/A)and second time pull out I/A needle,the total score of anterior chamber changes in the arched corneal incision group was 113,while the stepped plane corneal incision group was 186 points,the difference between the two groups was statistically significant(Z=-4.667,P=0.000).2.Corneal incision leakage at the end of the operation:in the soft nucleus group,the total score of the arched corneal incision group was 34 points,and the total score of the stepped plane corneal incision group was 60 points,the difference was statistically significant(Z=-2.412,P<0.05).In hard nucleus group,the total scores of the arched corneal incision group were 7 points,and the total scores of the stepped plane corneal incision group were 15 points,the difference being statistically significant(Z=-3.032,P=0.002).In all cataracts,the total scores of the arched corneal incision group were41 points,and the total scores of the stepped plane corneal incision group were 75points,the difference was statistically significant(Z=-3.384,P=0.001).3.Postoperative corneal astigmatism:three months after surgery,regular corneal astigmatism was(1.48±1.01)D in the arched corneal incision group,which was slightly higher than that(1.40±0.90)D before surgery,and the difference was not statistically significant(P>0.05).three months after surgery,regular corneal astigmatism was(1.36±0.73)D after operation in the stepped corneal plain incision group,which was higher than that(1.09±0.54)D before operation,and the difference was statistically significant(P<0.05).There was no significant difference in corneal astigmatism between 2 groups before and after operation(P>0.05).Postoperative irregularities corneal astigmatism:postoperative irregularities corneal astigmatism in arched corneal incision group was(0.31±0.26)μm,which was higher than that[(0.25±0.20)μm]before surgery,and the difference was statistically significant(P<0.05).The irregular astigmatism of the cornea was(0.26±0.14)μm in the stepped plane corneal incision group after surgery,which was higher than that[(0.21±0.12)μm]before surgery,and the difference was statistically significant(P<0.05).There was no significant difference in corneal irregular astigmatism before and after operation between 2 groups(P>0.05).4.Postoperative corneal endothelial cell counting:3months after surgery,the corneal endothelial counting in the arched corneal incision group was(1589.75±563.66)cells/mm~2,which was lower than that(2371.67±268.81)cells/mm~2,and the difference was statistically significant(P<0.05).The number of corneal endothelium was(1869.04±559.69)cells/mm~2in the stepped plane corneal incision group,which was lower than that(2536.77±334.16)cells/mm~2,and the difference was also statistically significant(P<0.05).There was no significant difference in corneal endothelial counting before and after operation between 2groups(P>0.05).Conclusion:1.Both arched corneal incisions and stepped plane corneal incision have good safety.2.During phacoemulsification and aspiration,arched corneal incision had better anterior chamber stability than stepped plane corneal incision.3.In the process of phacoemulsification,the degree of leakage of arched corneal incision was less than that of stepped plane corneal incision.4.The surgically induced astigmatism of the arched corneal incision was less than that of the stepped plane corneal incision in the early postoperative period.5.Both arched corneal incision and stepped plane corneal incision can cause corneal endothelial cell loss to the same degree during phacoemulsification and aspiration. |
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