目的：初步探讨不同撕囊直径下行囊袋内超声乳化对角膜和血-房水屏障的影响。

方法：选取2016-05-01/2017-04-31在潍坊眼科医院行飞秒激光辅助超声乳化手术的白内障患者(78例100眼)。术前按照撕囊直径分为试验组36例50眼，术中撕囊直径4.7mm； 对照组42例50眼，术中撕囊直径6.0mm。观察并分析两组患者术中平均超声能量和有效超声时间，术前和术后1d，1wk，2mo的最佳矫正视力、中央角膜厚度、房水闪辉细胞，术后2mo的角膜内皮细胞计数变化。

结果：两组患者术前最佳矫正视力、晶状体核硬度分级、中央角膜厚度、术中平均超声能量及有效超声时间均无统计学差异(P>0.05)。两组术后各时间点的最佳矫正视力比较，差异没有统计学意义(P>0.05)。以各时间点中央角膜厚度与术前中央角膜厚度差值作为各时间点中央角膜厚度变化值，结果显示，术后1d，1wk试验组患者的中央角膜厚度变化小于对照组，差异有统计学意义(P<0.05)； 术后2mo中央角膜厚度变化比较，差异无统计学意义(P>0.05)。术后1d，1wk试验组患者的房水闪辉细胞数低于对照组； 至术后2mo，两组间差异无统计学意义(P>0.05)。术后2mo试验组角膜内皮细胞丢失率明显低于对照组，差异有统计学意义(P<0.05)。

结论：小直径撕囊行囊袋内超声乳化能够减少术中超声乳化能量对角膜的损伤，同时减少对血-房水屏障的破坏，患者术后恢复更快。

METHODS: Totally 78 cases(100 eyes)with cataract were treated by femtosecond laser assisted phacoemulsification. The patients were randomly divided into two groups. There were 36 cases(50 eyes)in experimental group, in which the capsulotomy diameter was 4.7mm, and 42 cases(50 eyes)in the control group, in which the capsulotomy diameter was 6.0mm. Phacoemulsification power and time were recorded for each procedure. Follow-up exams were performed on 1d, 1wk and 2mo after surgery. Preoperative and postoperative best corrected visual acuity, central corneal thickness, aqueous flare, corneal endothelial cell count were assessed for the two groups.

RESULTS: No significant difference was found on preoperative best corrected visual acuity(BCVA), hardness of the lens nucleus, centrel corneal thickness(CCT)and the effective phaco time and the average phaco power of the two groups(P>0.05). There was also no statistically significant difference on BCVA between the two groups after surgery(P>0.05). The change of central corneal thickness and the aqueous flare cells in the experimental group were less than those in the control group at 1d and 1wk postoperatively(P<0.05), while the difference was not obvious at 2mo after(P>0.05). The rate of lost corneal endothelial cell was significantly lower in the experimental group than the control group at 2mo postoperatively(P>0.05).

CONCLUSION: The phacoemulsification with small capsulotomy diameters decreases the injury to the corneal and blood aqueous barrier. The patients recovered more quickly.