目的：探究飞秒激光辅助超声乳化白内障手术(FLACS)对年龄相关性白内障(ARC)患者角膜散光和手术源性散光(SIA)值的影响。

方法：将我院收治的年龄相关性白内障患者152例233眼，按照经济条件和自愿原则分为行FLACS的研究组(70例107眼)和行传统白内障超声乳化术(TS)的对照组(82例126眼)，比较两组角膜散光度、SIA值等指标。

结果：研究组有效超声时间、平均超声能量和总手术时间均少于对照组(P<0.05)，两组组间术前和术后1、3mo眼压比较，差异无统计学意义(P>0.05)； 两组不同时间点眼压比较，差异有统计学意义(P<0.05)； 两组眼压均呈下降趋势(P<0.05)； 两组Ⅱ级核、Ⅲ级核术中超声乳化累积能量复合参数(CDE)值比较，差异有统计学意义，两组Ⅲ级核术中CDE值均高于Ⅱ级核(P<0.05)； 两组不同时间点裸眼视力和最佳矫正视力比较，差异均有统计学意义(P<0.05)； 两组裸眼视力和最佳矫正视力均呈明显改善(P<0.05)，研究组术后1mo裸眼视力和最佳矫正视力均优于对照组(P<0.05)，术后3mo无明显差异(P>0.05)； 两组组间和不同时间点角膜散光度比较，差异均无统计学意义(P>0.05)； 两组术后1、3mo手术源性散光组间比较，差异均无统计学意义(P>0.05)； 术后3mo手术源性散光均低于术后1mo(P<0.05)； 两组不同时间点角膜内皮细胞计数比较，差异有统计学意义(P<0.05)，研究组术前和术后1mo角膜内皮细胞计数比较，差异无统计学意义(P>0.05)； 对照组术后1mo角膜内皮细胞计数低于术前(P<0.05)； 两组术前和术后1mo角膜内皮细胞计数组间比较，差异均无统计学意义(P>0.05)； 研究组术后3mo角膜内皮细胞计数明显多于对照组(P<0.05)； 研究组术后1、3mo角膜内皮丢失率显著低于对照组(P<0.05)。

结论：FLACS可有效改善ARC患者术后视力，并未增加术后角膜散光和SIA。

METHODS: Totally 152 cases of age-related cataract patients(233 eyes)admitted to our hospital were divided into the study group(n=70, 107 eyes, given the FLACS)and the control group \〖n=82, 126 eyes, given the traditional phacoemulsification cataract surgery(TS)\〗 according to the economic conditions and voluntary principles. Corneal astigmatism degree and SIA value were compared between the two groups.

RESULTS: The effective ultrasound time, average ultrasound energy, and total operative time in the study group were less than those in the control group(P<0.05). There was no significant difference in the intraocular pressure between the two groups before operation and at 1 and 3mo after operation(P>0.05). The difference in intraocular pressure was statistically significant of the two groups at different time points(P<0.05). The two groups showed a downward trend in intraocular pressure(P<0.05). There were statistically significant differences in the accumulated energy complex parameter(CDE)values of phacoemulsification between the two groups of grade Ⅱ nuclear and grade III nuclear surgery, and the intraoperative CDE value of grade Ⅲ nuclear in the two groups was higher than that of grade Ⅱ nuclear(P<0.05). The difference in visual acuity and best corrected visual acuity between the two groups at different time points was statistically significant(P<0.05). The uncorrected visual acuity and best corrected visual acuity were significantly improved in the two groups(P<0.05). The uncorrected visual acuity and best corrected visual acuity in the study group were better than those in the control group at 1mo after operation(P<0.05), but there was no significant difference at 3mo after operation(P>0.05). There was no significant difference in corneal astigmatism between the two groups and at different time points(P>0.05). There was no significant difference in surgical astigmatism between-groups at 1 and 3mo after operation(P>0.05).The surgical astigmatism at 3mo after operation was lower than that at 1mo after operation(P<0.05). There were significant differences in corneal endothelial cell counts between the two groups at different time points(P<0.05). There was no significant difference in corneal endothelial cell counts in the study group before operation and at 1mo after operation(P>0.05). The corneal endothelial cell counts in control group at 1mo after operation was lower than that before operation(P<0.05). There was no significant difference in the corneal endothelial cell counts between the two groups before operation and at 1mo after operation(P>0.05). The corneal endothelial cell counts in the study group were significantly more than those in the control group at 3mo after operation(P<0.05). The corneal endothelial loss rate was significantly lower in the study group at 1 and 3mo after operation than that in the control group(P<0.05).

CONCLUSION: FLACS can effectively improve the postoperative visual acuity in patients with age-related cataract, and it will not increase the postoperative corneal astigmatism and SIA.