為了比較不同白內障手術後之發炎反應,吾人使用雷射前房蛋白質及細胞測定儀來定量地測定術後前房蛋白質的濃度。其中,15位病人共17眼(平均年齡57.7±13.2歲)接受了晶體乳化術及後房式人工水晶體之植入;20位病人共21眼(平約年齡64.8±11.5歲)接受了囊外白內障摘除術及後房式人工水晶體之植入,而17位病人共18眼(平均年齡67.2±9.2歲)除了接受囊外白內障摘除,後房式人工水晶體之植入,同時加做翼狀贅片之切除。吾人測定了手術前一天、手術後第一天、第二天、第一週、第一個月及第二個月之前房蛋白質之濃度,並比較了術後第二個月之角膜散光度數。所有之統計均使用雙樣本測驗來比較。 吾人發現,三組病人術前之前房蛋白質濃度無顯著差異;晶體乳化術者,自術後第一天直至第二個月,前房蛋白質濃度約顯著低於囊外白內障摘除者或囊外白內障摘除加做翼狀贅片切除者;而囊外白內障摘除者則在術後第一天及第二天顯著低於囊外白內障摘除加做翼狀贅片切除者。晶體乳化術者,其術後兩個月之角膜散光度數(平均1.20±1.01D)亦顯著低於囊外白內障摘除者(平均2.30±1.50D)及囊外白內障摘除加做翼狀贅片切除者(平均2.15±1.53D)。 吾人認為,晶體乳化術由於切口較小,故對血液一前房液屏障之損害也最小,且傷口復原最快,故術後之發炎反應最小,且術後角膜散光最少;而加做翼狀贅片切除則增強了術後的發炎反應,然而,在局部給予類固醇的作用下,此差異到了術後第一週即不再顯著。
In order to compare the degree of postoperative inflammation following various cataract surgeries, we use laser flare-cell meter to quantitatively measure the protein concentration in aqueous humor. There were 17 eyes of 15 patients (mean age 57.7±13.2 years old) who received phacoemulcification and implantation of PCIOL; 21 eyes of 20 patients (mean age 64.8±11.5 years old) received ECCE and PCIOL implantation; 18 eyes of 17 patients (mean age 67.2±9.2 years old) received ECCE and PCIOL implantation plus pterygium excision. Aqueous flare count was measured at preoperative 1 day, postoperative 1 day, 2 days, 1 week, 1 month and 2 months. Keratometric cylinder at postoperative 2 months was also measured. All values were compared with two sample t test. We found that aqueous flare count of phacoemulsification group was significantly lower than ECCE or ECCE plus pterygium excision group from postoperative 1 day to 2 months; aqueous flare count of ECCE group was significantly lower than ECCE plus pterygium excision group only at postoperative 1 and 2 days. Keratometric cylinder of phacoemulsification group at postoperative 2 months (1.20±1.01 D)ws significantly lower than ECCE (2.30±1.50 D) or ECCE plus pterygium excision group (2.15±1.53 D). it is postulated that smaller wound of phacoemulsification caused less disruption of blood-aqueous barrier, less postopertive inflammation, more rapid wound healing, and less keratometric astigmatism. The addition of pterygium excision augmented postoperative inflammation; however, under the effect of topical steroid, the difference was no more significant after postoperative 1 week.