目的：分析撕囊碎核镊预劈核技术在Ⅳ级硬核白内障超声乳化手术中应用的优势。

方法：前瞻性研究。纳入年龄相关性Ⅳ级硬核白内障患者100例100眼，利用随机数表法随机分为撕囊碎核镊预劈核组(A组)50例50眼，拦截劈核组(B组)50例50眼。对两组的术前术后角膜内皮细胞计数、术中超声乳化能量释放时间(US time)、术后角膜内皮细胞丢失率、术后1、7d角膜水肿分级计数情况以及术前术后最佳矫正视力(BCVA)进行比较和统计学分析。

结果：A组平均US time为26.66(16，40)s，低于B组36.12(23，46)s(Z=-5.65，P<0.01)。术后3mo，A组平均角膜内皮细胞计数为2308.12±368.18cell/mm²，高于B组2104.06±379.87cell/mm²(t=2.728，P=0.008)。术后3mo，A组平均角膜内皮细胞丢失率10%(8%，12%)，低于B组17%(14%，20%)(Z=13.231，P<0.01)。术后1d角膜水肿为0、1、2、3、4级的眼数，在A组分别为0、23、21、6、0眼，在B组分别为0、9、26、15、0眼。A组角膜水肿轻于B组(Z=10.514，P=0.005)。术后1d A组患者BCVA优于B组患者，两组不同等级BCVA的眼数分布有差异(Z=7.176，P=0.029)。术后3mo两组不同等级BCVA的眼数分布无差异(Z=2.377，P=0.372)。

结论：与拦截劈核技术相比，在Ⅳ级硬核白内障超声乳化手术中，撕囊碎核镊预劈核技术辅助白内障超声乳化手术使用超声能量少，角膜内皮细胞损伤小，适用于硬核白内障手术。

METHODS: Prospective study. A total of 100 cases(100 eyes)with age-related grade IV hard cataract were included and randomly divided into 2 groups according to random number table, with 50 patients(50 eyes)in CCFP technique group(group A)and 50 cases(50 eyes)in stop-and-chop technique group(group B). The corneal endothelial cell count before and after operation, intraoperative US time, postoperative corneal endothelial cell loss rate, corneal edema grade at 1 and 7d and best corrected visual acuity(BCVA)were compared and statistically analyzed.

RESULTS: The mean US time of group A was lower than that of group B [26.66(16, 40)s vs. 36.12(23, 46)s; Z=-5.56, P<0.01]. The mean corneal endothelial cell count in group A was higher than that in group B at 3mo after operation(2308.12±368.18cell/mm² vs. 2104.06±379.87cell/mm²; t=2.728, P=0.008), and the loss rate of corneal endothelial cells in group A was lower than that in group B at 3mo after operation [10%(8%, 12%)vs. 17%(14%, 20%); Z=13.231, P<0.01]. The number of eyes with corneal edema of grade 0, 1, 2, 3 and 4 on 1d after surgery was 0, 23, 21, 6 and 0 in group A, respectively, while it was 0, 9, 26, 15 and 0 respectively in group B. Corneal edema in group A was less than that in group B(Z=10.514, P=0.005). The BCVA of group A was better than that of group B at 1d after operation, and there was significant difference in the number of eyes with different BCVA grades between the two groups(Z=7.176, P=0.029). There was no significant difference in the number of eyes with different grades of BCVA between the two groups at 3mo after surgery(Z=2.377, P=0.372).

CONCLUSION: Compared with the stop-and-chop technique, CCFP technique uses less ultrasonic energy, has less damage to corneal endothelial cells and is suitable for hard cataract surgery.