目的 评价飞秒激光辅助白内障超声乳化手术在部队晶状体半脱位患者中的应用效果。方法 回顾性分析武警河南总队医院2017-01至2021-10收治的部队晶状体半脱位白内障患者40例(40眼),将飞秒激光辅助白内障超声乳化吸除联合人工晶状体植入和囊袋张力环植入术患者作为观察组(19例),将常规白内障超声乳化吸除联合人工晶状体植入和囊袋张力环植入术患者作为对照组(21例)。观察指标包括视力,总手术时间,超声累积释放能量,等效球镜,术后全眼总高阶像差、球差、彗差、三叶草像差,以及并发症的发生率。结果 两组术前最佳矫正远视力对比,差异无统计学意义。两组术后各时间点的最佳矫正远视力与术前相比,差异有统计学意义(P＜0.01)。术后1 d、1个月观察组的最佳矫正远视力明显优于对照组,差异有统计学意义(P＜0.05);术后3、6个月,两组最佳矫正远视力对比差异无统计学意义。观察组术后各时间点的裸眼远视力明显优于对照组,总手术时间[(18.72±4.33)min]明显少于对照组[(22.51±5.64)min],术中超声累积释放能量[(7.34±5.50)％]明显少于对照组[(11.28±6.46)％],差异均有统计学意义(P＜0.05)。术后6个月,两组的残余屈光度在等效球镜±0.5D、±0.75D-±1.00D和±1.00D以外等各范围构成比有统计学差异(χ²=2.361, P=0.018)。术后6个月,观察组全眼总高阶像差、球差、彗差、三叶草像差的均方根值与对照组相比,差异均有统计学意义(P＜0.05)。观察组并发症的发生率(26.32％)明显低于对照组(76.19％),差异有统计学意义(P=0.002)。结论 飞秒激光辅助白内障超声乳化吸除联合囊袋张力环和人工晶体植入术,为部队晶状体半脱位白内障患者提供了良好的视力和视觉质量,手术安全性好。

Objective To evaluate the clinical effect of femtosecond laser-assisted phacoemulsification in treating military lens subluxation patients. Methods A total of 40 cases (including 40 eyes) with lens subluxation, who were treated in Henan Provincial Corps Hospital of Chinese People's Armed Police Force from January 2017 to October 2021, were divided into two groups. Patients undergoing femtosecond laser-assisted phacoemulsification with intraocular lens and capsular tension ring implantation were assigned to the observation group (19cases), and those undergoing conventional phacoemulsification with intraocular lens and capsular tension ring implantation were assigned to the control group(21cases).Visual acuity, operative time, cumulative dissipated energy(CDE), spherical equivalent(SE), high order aberration, spherical, coma, trefoil, and the surgical incidence of complications were recorded. Results There was no significant difference between the two groups in best corrected distance visual acuity (BCDVA) before the surgery. After the surgeries, the BCDVA was significantly improved in both groups (P<0.01).At the postoperative time point of one day and one month, the BCDVA of the observation group was significantly better than that of the control group (P<0.05), but at the point of three months and six months, there was no significant difference. At the point of 1 day, 1 month, 3 months and 6 months, the uncorrected distance visual acuity (UCDVA) of the observation group was significantly better (P<0.01). The total operation time of the observation group [(7.34±5.50) min] was significantly lower than that of the control group [(11.28±6.46) min], the cumulative dissipated energy of the observation group [(18.72±4.33) %] was significantly lower than that in the control group [(22.51±5.64)%], and the differences were statistically significant (P<0.05).At 6 months postoperatively, in the equivalent spherical of the residual diopter in the range of ±0.5 D and ±0.75 D-±1.00 D and out of the range±1.00 D,there was statistically significant difference between the two groups(χ²=2.361,P=0.018).At 1 month, 3 months and 6 months postoperatively, the root mean square of the high order aberration, spherical, coma and trefoil in the observation group were significantly better than those in the control group, and the difference was statistically significant(P<0.05). The incidence of surgical complications of the observation group (26.32%) were significantly lower than that of the control group (76.19%), and the difference was statistically significant(P=0.002). Conclusions Femtosecond laser-assisted phacoemulsification with intraocular lens and capsular tension ring implantation is safe, which can provide better vision and better visual quality for the military lens subluxation patients.