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超声乳化白内障吸除术后角膜内皮细胞损伤和修复的研究
作者姓名:Xie LX  Yao Z  Huang YS  Ying L
作者单位:266071青岛,山东省眼科研究所
摘    要:目的探讨超声乳化白内障吸除术后角膜内皮细胞损伤和修复的特点及角膜水肿的临床分级标准.方法对105例(105只眼)老年性白内障患者行超声乳化白内障吸除术,术后使用裂隙灯显微镜观察角膜水肿程度,并记录水肿消退时间;术前和术后3个月分别使用接触型角膜内皮显微镜观察角膜上、中、下部内皮细胞的密度变化.结果角膜水肿程度为 0~4级者的角膜内皮细胞丢失率分别为4.6%、14.9%、40.8%、67.0%及84.4%;1~3级者角膜水肿的消退时间分别为(2.1±0.7)、(5.6±1.9)、(21.8±7.1)d.术后3个月角膜上、中、下部内皮细胞平均密度分别为(2006±546)、(1979±545)、(1754±543)个/mm2;上部与下部、中部与下部比较,差异均有显著意义(P=0.025,0.030);上部与中部比较,差异无显著意义(P=0.921).角膜上、中、下部内皮细胞密度的平均下降值分别为(627±496)、(656±492)、(1026±509)个/mm2;上部与下部、中部与下部比较,差异均有显著意义(P=0.017,0.027);上部与中部比较,差异无显著意义(P=0.867).结论将超声乳化白内障吸除术后角膜水肿程度分为0~4级,可明确表示角膜内皮细胞的损伤程度,为临床评估预后提供重要参考.超声乳化白内障吸除术后角膜内皮细胞的损伤部位以角膜下部为主,且术后3个月角膜内皮细胞密度无法恢复至正常水平.

关 键 词:超声乳化吸除术  角膜内皮细胞损伤  修复  白内障  术后并发症  角膜水肿

Corneal endothelial damage and its repair after phacoemulsification
Xie LX,Yao Z,Huang YS,Ying L.Corneal endothelial damage and its repair after phacoemulsification[J].Chinese Journal of Ophthalmology,2004,40(2):90-93.
Authors:Xie Li-xin  Yao Zhan  Huang Yu-sen  Ying Liang
Institution:Shandong Eye Institute & Hospital, Qingdao 266071, China. lixinxie@public.qd.sd.cn
Abstract:OBJECTIVE: To introduce a grading system for corneal edema after phacoemulsification and to study the corneal endothelial damage and its repair after phacoemulsification. METHODS: One hundred and five senile cataracts after phacoemulsification were included. Corneal edema was categorized into grades 0 to 4. Endothelial densities at various locations of the cornea were measured with specular microscopy before and three months after surgery. RESULTS: The corneal endothelial cell loss rate was 4.6%, 14.9%, 40.8%, 67.0% and 84.4% in eyes with corneal edema from grades 0 to 4, respectively. Time required for resolution of corneal edema was (2.1 +/- 0.7) days (grade 1), (5.6 +/- 1.9) days (grade 2) and (21.8 +/- 7.1) days (grade 3). The endothelial cell densities at superior, mid and inferior portions of the cornea were (2006 +/- 546) cells/mm(2), (1979 +/- 545) cells/mm(2) and (1754 +/- 543) cells/mm(2) respectively at 3 months after phacoemulsification. Postoperative endothelial cell loss at superior, mid and inferior portions of the cornea was (627 +/- 496) cells/mm(2), (656 +/- 492) cells/mm(2) and (1026 +/- 509) cells/mm(2) respectively. The difference in postoperative endothelial cell densities between the superior and inferior portions of the cornea was statistically significant (P = 0.017), so was the difference between mid and inferior portions of the corneas (P = 0.027). There was no statistically significant difference between the superior and mid portions of the cornea (P = 0.867). CONCLUSION: The grading system for corneal edema is helpful in evaluating the severity of endothelial damage after phacoemulsification and can be used to predict the outcome of the cornea. The major area of endothelial injury after phacoemulsification occurs at the inferior portion of the cornea.
Keywords:Phacoemulsification  Cataract  Endothelium  Corneal  Corneal edema
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