超声乳化吸除联合人工晶状体植入治疗穿透性角膜移植术后白内障

目的:对穿透性角膜移植术后白内障进行超声乳化吸除术,分析其对角膜移植片内皮细胞的影响因素。方法:单纯穿透性角膜移植术后11眼,未出现排斥反应7眼,排斥反应控制后3mo以上3眼,角膜缝线已拆除。术前裸眼视力光感～0.1,术前及术后均检测角膜植片中央内皮细胞计数,晶状体核III～IV级。手术方式为超声乳化吸除联合人工晶状体植入术,术中平均超声能量14.82%±0.47%,流速26mL/min,负压180～200mmHg(U/SPower),200～210mmHg(U/SPulse)。超声时间1.5～2.5(1.95±0.47)min。术后常规抗生素及激素眼液点眼。结果:术后最佳矫正视力0.2～0.5,均较术前提高。术后2～3d,角膜植片少许内皮皱褶,术后4d角膜恢复透明。术前术后角膜移植片中央部位内皮细胞计数分别为:607～1998(1248.09±408.52)个/mm2和601～1899(1184.36±373.92)个/mm2,术后内皮细胞丢失率为5.11%,与术前比较采用配对t检验得t=3.6418,P<0.05,有统计学意义。随访3mo以上,角膜植片保持透明,内皮细胞稳定。未发现大泡样角膜病变。结论:穿透性角膜移植术后白内障,超声乳化术式安全有效。

Phacoemulsification with intraocular lens implantation in treatment for cataract after penetrating keratoplasty

·AIM:To analyze the influencing factors of phacoemul-sification,which was performed for cataract after penetrating keratoplasty(PKP),to endothelial cells of corneal graft..METHODS:A total of 11 eyes had cataract after simple penetrating keratoplasty,7 eyes of which did not have immune rejection,3 eyes of which were found immune rejections but were controlled after treatment for over 3 months.Preoperative naked visual acuity was light perception to 0.1.The number of central endothelial cells of corneal graft was counted before and after the operation.The hardness of lens nucleus was III to IV grade.Corneoscleral tunnel-like incision was chosen under peribulbar anesthesia.Phacoemulsification was performed and injectable AMO Sensar intraocular lens was implanted in the capsular pocket.The procedure was smooth in all patients.Ultrasonic time lasted for 1.5-2.5 minutes(1.95±0.47 minutes).The average U/S power was 14.82±0.47%;aspiration rate 26mL/min,negative pressure 180-200 mmHg(U/S Power)and 200-210 mmHg(U/S Pulse).Conventional antibiotic and steroid eyedrops were topically used after the operation..RESULTS:The postoperative best corrected vision was 0.2-0.5,improved than before the operation.At 4 days after the operation,corneas recovered to transparency.Endothelial cells density before and after the cataract surgery was 607-1998/mm2(1248.09±408.52/mm2)and 601-1899/mm2(1184.36±373.92/mm2).The endothelial cell loss rate was 5.11%.There was statistically significant difference between preoperative and postoperative results(t=3.6418,P<0.05).The corneal grafts were transparent and endothelial cells were stable during more than three months of follow-up.No bullous keratopathy was found..CONCLUSION:Phacoemulsification is safe and effective for cataract after PKP..