超声乳化白内障吸除术前后角膜基质层活体形态学变化的研究  

Corneal stromal layer changes of senile cataract patients with phacoemulsification in vivo

作　　者：张健[1] 邹留河[2] 郭丽[1] 李航[2] 

机构地区：[1]首都医科大学宣武医院眼科,北京100053 [2]首都医科大学附属北京同仁医院北京同仁眼科中心

出　　处：《中华眼科杂志》2008年第7期615-621,共7页Chinese Journal of Ophthalmology

基　　金：北京市委组织部优秀人才资助项目（20051D0501821）

摘　　要：目的了解活体状态下年龄相关性白内障患者超声乳化白内障吸除术前后角膜基质层形态学变化规律。方法为观察型系列病例研究。选取19例（22只眼）行超声乳化白内障吸除术的年龄相关性白内障患者，在术前、术后1周、术后1、3及6个月不同时间，应用非接触型角膜内皮镜（NCSM）和共聚焦显微镜（CMTF）对角膜中央区厚度和角膜前、后基质层细胞数目进行统计学比较，并观察角膜基质层形态学变化规律。文中3组计量资料的统计学分析方法分别选用具有一个重复测量的单因素设计定量资料的方差分析，并采用最小显著差数法对多样本均数进行两两比较。结果（1）角膜厚度：术后1周与术前和术后1、3及6个月各时间点两两比较，角膜明显增厚，差异有统计学意义（P=0．020、0．033、0．005、0．008），其余各时间点角膜厚度两两比较，差异无统计学意义（术前与术后1个月比较，P=0．135，与术后3个月比较，P=0．179，与术后6个月比较，P=0．223；术后1个月与术后3个月比较，P=0．072，与术后6个月比较，P=0．086；术后3个月与术后6个月比较，P=0．491）。（2）角膜基质层细胞密度：后基质层细胞密度术前为（627±184）个／nun。；仅有术后1个月时，后基质层细胞密度与术前比较，其细胞数目量明显增多，差异有统计学意义（P=0．042）。前基质层细胞密度术前为（859±137）个／mm^2，术前与术后各时间点前基质层细胞密度相互比较差异无统计学意义（术前与术后1周、1、3及6个月不同时间比较，P=0．825、0．752、0．171、0．288；术后1周与术后1、3及6个月不同时间比较，P=0．957、0．162、0．401；术后1个月与术后3及6个月不同时间比较，P=0．128、0．407；术后3个月与术后6个月比较，P=0．059）。（3）角膜基质层形态学改变：术前有4只眼中央后基质层中见到微�Objective To observe and investigate corneal stromal layer＇s changes of healthy elderly with phacoemulsification operation. Methods The experimental design was prospective, one replicated measurement, one interventional method case series. Analysis of central corneal stromal layer＇s changes （including corneal thickness, keratocyte density of anterior and posterior corneal stromal layer and morphological changes） of 19 patients （22 eyes） just before operation and 1 week, 1 month, 3 months and 6 months after operation with CMTF and NCSM. The statistical test method of the three parameter groups was least significant difference. The significant sterling was P 〈 0. 05. Results （ 1 ） Corneal thickness ： 1 week after operation, corneal thickness was significantly thicker than before operation as well as 1 month, 3 months and 6 months after operation （ P 〈 0. 05 ）. Comparisons of the differences of other pairs of corneal thickness showed no significant differences （P 〉 0. 05）. （2） Keratocyte density ： Keratocyte density in the posterior stromal Before operation was （627±184）/mm^2 and only the 1 month after operation group was significantly higher than before operation （P 〈 0. 05 ）. Keratocyte density in the anterior stromal before operation was （859 ± 137）/mm^2. Comparisons of the differences of each pair of groups before and after operation showed no significant differences （P 〉0. 05）. （3） CMTF images displayed micrefolds （4 eyes） in the middle and posterior stromal layers before operation. Different changes in stromal edema at an early stage after operation were observed within 3 months after operation, including different degrees of high-reflecting images and pathological micrefolds （16 eyes）. Keratocyte activation and fibrehlast-like cells could also be found after operation. Conclusions Phacoemulsification can injure the corneal stromal layers. CMTF test is a useful method to reveal corneal pathological changes in four-dimension space （three-

关 键 词：显微镜检查 共焦 白内障 角膜 基质 超声乳化白内障吸除术 

分 类 号：R686[医药卫生—骨科学]