目的：对比手法小切口白内障囊外摘除术和超声乳化白内障摘除术对Ⅱ～Ⅲ级核白内障患者角膜内皮细胞影响，探讨目前最常用的这两种手术治疗Ⅱ～Ⅲ级核年龄相关性白内障的差异性。

方法：回顾性研究。选择2013-06/2015-12我院收治的角膜内皮细胞密度大于2 000个/mm²，晶状体核为Ⅱ～Ⅲ级，随访时间至少6mo，资料完整的年龄相关性白内障患者84例84眼，其中手法小切口白内障囊外摘除联合人工晶体植入手术42例42眼(小切口组)，白内障超声乳化联合人工晶状体植入手术42例42眼(超声乳化组)。记录并比较术前、术后1d，1wk，1、6mo两组患者的裸眼视力和角膜内皮细胞密度。

结果：两组患者术前基本资料、裸眼视力和角膜内皮细胞密度及六角形细胞比例及晶体核分级的比较差异均无统计学意义(P>0.05)。小切口组和超声乳化组术后裸眼视力较术前均明显改善，差异均有显著统计学意义(χ²=148.01，P<0.001； χ²=165.97，P<0.001)，并且随着时间的推移，裸眼视力均逐渐改善； 术后两组角膜内皮细胞密度较术前均明显减少，差异均有统计学意义(F=37.74，P<0.001； F=24.56，P<0.001)。超声乳化组术后1d，六角形细胞比例较术前明显下降(P=0.002)，但术后1wk即恢复至手术前水平(P=0.894)。术后每个观测点两组间裸眼视力、角膜内皮细胞计数与六角形细胞比例均无统计学差异(P>0.05)。

结论：手法小切口白内障囊外摘除手术及超声乳化白内障摘除术均可提高裸眼视力，术后角膜内皮细胞密度下降，而角膜内皮六角形细胞的比例影响不明显，两种手术方式对于角膜内皮细胞密度大于2 000个/mm²，晶状体核为Ⅱ～Ⅲ级核的白内障患者具有相同的疗效和安全性。

METHODS: Retrospective study. We retrospectively evaluated the data of age-related cataract patients who had completed surgery in our hospital between June 2013 and December 2015. There were 84 eyes of 84 patients. The corneal endothelial cell density of all the patients were greater than 2000/mm² and lens nucleus were grade Ⅱ-Ⅲ. The patients were divided into manual small incision cataract surgery(MSICS)group and phacoemulsification(Phaco)group. MSICS group included 42 cases(42 eyes)and Phaco group included 42 cases(42 eyes). Postoperative evaluations were performed at 1d, 1wk, 1mo and 6mo and included uncorrected visual acuity(UCVA), corneal endothelial cell density and the proportion of hexagonal cells.

RESULTS: There were no statistically significant differences of the two groups in preoperative basic data, UCVA, corneal endothelial cell density and the proportion of hexagonal cells, nuclear classification. The postoperative UCVA were significantly improved in both groups(χ²=148.01, P<0.001; χ²=165.97, P<0.001). The postoperative UCVA were on the rise as time goes on. The postoperative corneal endothelial cell density was obviously reduced in both groups compared with the preoperative(F=37.74, P<0.001; F=24.56, P<0.001). The proportion of hexagonal cells in Phaco group was declined at 1d(P=0.002)after the operation and returned to baseline by 1wk(P=0.894)after surgery. There was no significant difference between the two groups in UCVA, corneal endothelial cell density and the proportion of hexagonal cells at each observation point (P>0.05).

CONCLUSION: Manual small incision cataract surgery and phacoemulsification can indiscriminately improve UCVA and decrease the density of corneal endothelial cells. However, the change of hexagonal cells proportion was not obvious. These two surgeries for cataract patients with corneal endothelial cell density greater than 2000/mm², grade Ⅱ-Ⅲ lens nucleus have similar efficacy and safety.