方法：前瞻性队列研究。选取于2014-08/2016-01来我院就诊的行微切口超声乳化吸除联合人工晶状体植入术的白内障患者180例190眼，根据随机数字表法，将所有患者分为观察组80例85眼和对照组100例105眼。对照组患者采用传统微切口超声乳化吸除法进行治疗； 观察组患者采用飞秒激光辅助超声乳化吸除法进行治疗。收集两组患者的一般资料和临床资料，包括年龄、性别和术前、术后3mo每平方毫米角膜内皮细胞计数、术中累积释放能量值(cumulative dissipated energy，CDE)等。对患者的资料进行统计学分析。

结果：观察组患者Ⅱ级核组和Ⅲ级核组CDE水平明显低于对照组，差异有统计学意义(t=-2.456、-3.053，P=0.016、0.003)。Ⅱ级核组的CDE降低率为29.37%，Ⅲ级核组的CDE降低率为22.69%，明显低于Ⅱ级核组的CDE降低率。术前两组患者角膜内皮细胞密度比较差异无统计学意义(t=-0.816，P=0.416)； 术后3mo，观察组和对照组的角膜内皮细胞密度均有明显下降，差异有统计学意义(t=-2.094、6.043，P=0.038、<0.001)。术后3mo观察组角膜内皮细胞密度明显高于对照组，差异有统计学意义(t=2.575，P=0.011)。观察组患者角膜内皮细胞丢失率(7.68±4.23)%明显低于对照组(10.36±4.08)%。

结论：对于Ⅲ级核以下白内障患者，飞秒激光辅助白内障手术比传统微切口超声乳化手术能够更有效减少术中CDE水平，减少对角膜内皮细胞的损伤，安全性高。

METHODS: This was a prospective cohort study. We selected 180 patients(190 eyes)with cataract in our hospital from August 2014 to January 2016 treated with phacoemulsification combined with intraocular lens implantation. According to random number table, all patients were divided into observation group with 80 cases(85 eyes)and control group with 100 cases(105 eyes). Patients in the control group were treated by conventional phacoemulsification, and the observation group were treated by femtosecond laser assisted phacoemulsification. Two groups of patients with general information and clinical data, including age, sex, corneal endothelial cell count/mm² before and at 3mo after the operation, cumulative dissipated energy(CDE)of the two groups, were collected. Statistical analysis was performed.

RESULTS: In the observation group, the level of CDE in patients with lens hardness at class Ⅱ and Ⅲ was significantly lower than that of the control group(t=-2.456, -3.053, P=0.016, 0.003). The reduction rate of CDE in patients with lens hardness at class Ⅱ was 29.37%, and the rate of CDE in patients at class Ⅲ was 22.69%, which was significantly lower than that of CDE in class Ⅱ. Comparison of preoperative corneal endothelial cell density was not significantly different between the two groups(t=-0.816, P=0.416); at 3mo after surgery, the corneal endothelial cell density of the observation group and the control group significantly decreased(t=-2.094, 6.043, P=0.038, <0.01). At 3mo after operation, the density of corneal endothelial cells of observation group was significantly higher than that of the control group(t=2.575, P=0.011). In the observation group, the rate of corneal endothelial cell loss(7.68±4.23)% was significantly lower than that of the control group(10.36±4.08)%.

CONCLUSION: For cataract patients with class Ⅲ and below nuclear, femtosecond laser assisted cataract surgery can reduce the level of CDE and reduce the damage to corneal endothelium, which is safe and effective.