白内障超声乳化吸除术后角膜内皮细胞变化的研究

目的:观察不同类型白内障患者超声乳化吸除术后角膜内皮细胞的变化。方法:随机选取我院老年性白内障、糖尿病性白内障及高度近视并发性白内障患者各30例30眼,均行白内障超声乳化吸除联合人工晶状体植入手术,于术前及术后1wk采用非接触型角膜内皮显微镜行角膜内皮细胞密度及六角形细胞比例检查。结果:三组术前角膜内皮细胞密度及六角形细胞比例比较,差异无统计学意义(P>0.05)。三组术后1wk角膜内皮细胞密度分别为2 496.86±298.96/mm2,2 379.51±375.13/mm2,2 425.38±312.68/mm2,六角形细胞比例分别为(46.20±12.03)%,(43.44±13.99)%,(44.35±8.13)%。三组术后1wk角膜内皮细胞密度及六角形细胞比例均较术前减少,其差异均有统计学意义(P<0.05)。术后各组间比较,糖尿病性白内障组和高度近视并发性白内障组术后均较老年性白内障组术后降低,其中糖尿病性白内障组术后角膜内皮细胞密度和六角形细胞比例降低较明显,与老年性白内障组比较,其差异有统计学意义(P<0.05)。结论:糖尿病性白内障及高度近视并发性白内障患者角膜内皮对超声乳化手术的耐受性降低,对角膜内皮细胞应行准确术前评估及术中保护。

Study on corneal endothelial cells after phacoemulsification

AIM:To observe the changes of corneal endothelium after phacoemulsification cataract surgery in different types of cataract patients.

METHODS: Randomly selected age-related cataract, diabetic cataract and cataract of high myopia 30 eyes of 30 cases, respectively, in our hospital. All patients underwent phacoemulsification combined with intraocular lens implantation, corneal endothelial density and the percentage of hexagonal cells were measured by corneal endothelial cell instrument without touching before surgery and one week after surgery.

RESULTS: The difference of the preoperative corneal endothelial cell density and the percentage of hexagonal cells among three groups were not statistically significant(P>0.05). One week after surgery, the cell density in three groups were respectively 2 496.86±298.96/mm², 2 379.51±375.13/mm², 2 425.38±312.68/mm², the percentage of hexagonal cells were respectively(46.20±12.03)%,(43.44±13.99)%,(44.35±8.13)%. Both the cell density and the percentage of hexagonal cells one week after surgery were lower than those before operation. There were significant difference in three groups(P<0.05). Both the measurements in diabetic cataract group and cataract of high myopia group after surgery were lower than those in age-related cataract group, the cell density and the percentage of hexagonal cells in diabetic cataract group were lower obviously compared with those in age-related cataract group and the difference was significant(P<0.05).

CONCLUSION: The tolerance of corneal endothelial cell to phacoemulsification cataract surgery is lower in cataract with diabetes and high myopia. Corneal endothelium should be assessed preoperatively and protected intraoperatively.