Abstract:AIM:To compare the curative effect of different surgical methods combined with Toric intraocular lens(IOL)implantation on age-related hard nuclear cataract.
METHODS:According to retrospective study, 104 patients(104 eyes)with age-related hard nuclear cataract confirmed in the hospital between January 2020 and December 2021 were enrolled. They were divided into phacoemulsification group(52 eyes, phacoemulsification combined with Toric IOL implantation)and small-incision group(52 eyes, small-incision split nuclear technique in horizontal space combined with Toric IOL implantation)according to different surgical methods. The best corrected distance visual acuity(BCDVA), corneal astigmatism, number of corneal endothelial cells, proportion of normal hexagonal cells, tear film function and complications were compared between the two groups.
RESULTS:There was no significant difference in BCDVA(LogMAR)between the two groups before and at 3mo after surgery(all P>0.05), while BCDVA(LogMAR)was better in small-incision group than phacoemulsification group at 1wk after surgery(0.15±0.04 vs. 0.20±0.05, P<0.001). The corneal astigmatism of the patients in both groups was lower at 1wk and 3mo after surgery than that before surgery, and it was lower at 3mo than 1wk after surgery(all P<0.05), while there was no significant difference in corneal astigmatism between the two groups before and after surgery(all P>0.05). At 1wk and 3mo after surgery, number of corneal endothelial cells in small-incision group was more than that in phacoemulsification group(1wk after surgery: 2363.8±315.3 vs. 2231.4±326.4 cells/mm2, P<0.05; 3mo after surgery: 2414.6±245.7 vs. 2322.9±221.0 cells/mm2, P<0.05). Before and at 1wk after surgery, there was no significant difference in the proportion of normal hexagonal cells between the two groups(all P>0.05). At 3mo after surgery, proportion of normal hexagonal cells in small-incision group was higher than that in phacoemulsification group(21.77%±1.91% vs. 20.59%±1.65%, P<0.001). Before and at 3mo after surgery, there was no difference in break up time(BUT)or ocular surface disease index(OSDI)score between the two groups(P>0.05). At 1wk after surgery, BUT in small-incision group was longer than that in phacoemulsification group(6.8±0.8 vs. 5.9±1.0s, P<0.001)and OSDI score was lower than that in phacoemulsification group(17.62±5.47 vs. 20.34±6.18 points, P<0.05). The incidence of postoperative complications in small-incision group was lower than that in phacoemulsification group(3.9% vs. 17.3%, P<0.05).
CONCLUSION: Small-incision split nuclear technique in horizontal space combined with Toric IOL implantation can significantly improve visual acuity and astigmatism in patients with age-related cataract, with slight damage to corneal endothelium and tear film function.
