方法：对老年性白内障Ⅴ级以上棕褐色硬核患者分层随机抽样分成两组：A组40例40眼采用巩膜隧道切口超声乳化碎核，辅以联合手法娩核，B组40例40眼采用无缝线大切口白内障囊外摘除术(sutureless large-incision-manual cataract extraction，SLIMCE)，两组患者均联合后房型折叠人工晶状体植入。对比两组术后不同时期的最佳矫正视力、角膜散光值、手术时间、术中并发症、角膜水肿程度、眼压及角膜内皮细胞数量变化等。

结果：A组患者术后3、7d视力明显好于B组(P<0.05)，术后1d，1mo两组患者无统计学差异(P>0.05)； 术后1mo内A组角膜散光均小于B组，两组差异有统计学意义(P<0.05)； A组并发症少于B组，但差异无统计学意义(Fisher确切概率法，P=0.36)； 术后1d两组患者角膜水肿的发生率，差异有统计学意义(χ²=5.70，P<0.05)； 手术时间、术后7d角膜水肿反应、眼内压及术后角膜内皮细胞数量变化，A组与B组相比无统计学差异(P>0.05)。

结论：巩膜隧道切口超声乳化碎核辅以联合手法娩核是治疗Ⅴ级以上棕褐色硬核白内障优选手术模式。

METHODS: Totally 80 eyes of 80 patients with level V cataract were randomly stratified, divided into two groups. We operated with sclera tunnel incision phacoemulsification in Group A(40 eyes), combined with manual cataract extraction. Sutureless large-incision-manual cataract extraction(SLIMCE)was used in Group B(40 eyes). All cases were implanted posterior chamber folding intraocular lens. We compared the best corrected visual acuity, corneal astigmatism, operation time, intraoperative complications, corneal edema, intraocular pressure and corneal endothelial cells in two groups of different postoperative time.

RESULTS: The postoperative best corrected visual acuity at 3 and 7d of Group A were better than those of Group B(P<0.05), and there was no difference in the 1d and 1mo after surgery(P>0.05). The corneal astigmatism of 1mo after surgery was much smaller in Group A, and there was a significant statistical difference between two groups(P<0.05). Less intraopretative complications happened in Group A, but there was not statistical difference between two groups(by Fisher's exact test, P=0.36). There was a significant statistical difference in corneal edema of these two groups at 1d after surgery(χ²=5.70, P<0.05). There were no significant differences in operation time, postoperative corneal edema, intraocular pressure and corneal endothelial cells in two groups at 7d(P>0.05).

CONCLUSION: Sclera tunnel incision phacoemulsification combined with manual nuclear extraction would be a preferred surgical technique for level V cataract.