超声乳化白内障手术对年龄相关性白内障患者角膜内皮细胞的影响

目的:探讨年龄相关性白内障患者超声乳化白内障吸除术后角膜内皮细胞的变化及角膜内皮形态结构的变化。方法:选择在我院行超声乳化白内障吸除折叠人工晶状体植入术的年龄相关性白内障患者79例91眼,按晶状体核密度分为两组,其中Ⅲ级以下核(包括Ⅲ级核)43眼,Ⅲ级以上核48眼。在术前及术后3d时,应用非接触式角膜内皮显微镜观察其中央角膜的内皮细胞密度(CD值)及角膜内皮形态结构的变化。结果:CD值较术前均有不同程度的下降,Ⅲ级核以下(包括III级核)CD值下降6%,Ⅲ级核以上CD值下降13%。CD值随着晶状体核硬度上升,呈现下降趋势。术后细胞形态也发生改变,角膜内皮细胞变异系数(CV)值则增高,Ⅲ级核以下(包括Ⅲ级核)内皮细胞面积平均值及CV值变化均小于III级核以上。结论:老年患者角膜内皮对白内障超声乳化手术产生的损伤敏感,术前应将角膜内皮细胞镜作为常规检查,术中术者可根据患者核硬度随时调整能量和负压的参数组合,尽可能降低超声能量,缩短超声时间,最大限度地保护角膜内皮的正常功能,以提高手术成功率。

Study on the morphology of corneal endothelial cells after phacoemulsification

·AIM:To observe the corneal endothelial cells morpho-logy after phacoemulsification,and find out the regularity of corneal endothelial cells morphologic change and some related influencing factors.·METHODS:Seventy-nine cases 91 eyes with age-related cataract were chosen in this research.The phacoemul-sification was performed through the clear cornea combined with the foldable intraocular lens implantation.The cell density(CD),coefficient of variation(CV)of the endothelial cells in the central and incision cornea were examined preoperatively and 3 days postoperatively.·RESULTS:The level of postoperative CD decreased gradually,and the level of CV increased.Morphology of endothelial cells in the incision cornea showed a significant lower CD,higher CV than those in the central cornea at 3 days postoperatively.·CONCLUSION:In phacoemulsification through the clear cornea,the endothelial cells suffer from energy and mechanic injury.The corneal endothelial cells in incision are easier to be damaged than that in the central part during this surgery,We should pay more attention to the mechanic injury in elder patient,because it lead to more corneal endothelial cell loss.·