软壳技术在白内障超声乳化术中对角膜内皮的保护作用  

Efficacy of the soft-shell technique in the protection of corneal endothelium during phacoemulsification

作　　者：钟勇[1] 施维[2] 王韧琰[3] 金玉梅[1,2] 许鹏[1,2] 

机构地区：[1]中国医学科学院,100730 [2]北京协和医学院 [3]北京协和医院眼科

出　　处：《中国实用眼科杂志》2008年第7期657-660,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的评估软壳技术在白内障超声乳化摘除术中，对角膜内皮细胞的保护作用。方法选择2006年10月至2007年6月手术治疗的年龄相关性白内障患者80例90只眼，根据术中使用的黏弹剂不同随机分为两组：DuoVise组和1％透明质酸钠组，均行标准的透明角膜切口白内障超声乳化摘除及一片式折叠型后房人工晶状体植入术。观察比较两组患者术前和术后1周、1月和3月的视力、角膜内皮细胞密度（CD）、角膜内皮细胞平均面积（AVE）、角膜6角形内皮细胞的百分数（6A）以及中央角膜厚度。结果两组患者术前的视力、角膜内皮细胞密度、角膜内皮细胞平均面积、角膜6角形内皮细胞的百分数以及中央角膜厚度均无统计学意义，两组之间的超声乳化能量和时间的乘积（CDE）差异无统计学意义。术后l周、1月和3月的检查结果显示，两组患者间的角膜内皮细胞密度的减少、角膜内皮细胞平均面积的增加、角膜6角形内皮细胞的百分数数下降差异均有统计学意义（P〈0．05），而角膜内皮细胞计数降低在第1周的差异尤为明显（P=0．001）。两组术后1周和1月的中央角膜厚度对比差异显著有统计学意义（分别P=0．001，0．028），但在术后第3月则差异无统计学意义（P=0．221）。术后3月两组视力比较无统计学意义（P=0．764）。结论在白内障超声乳化摘除手术中使用软壳技术，充分发挥其中两种不同生物化学特性的黏弹剂的作用，可以更为有效地在术中保护角膜内皮细胞，从而减少术后角膜并发症的发生。Objective To evaluate the efficacy of the soft-shell technique by using DuoVisc （Viscoat＋Provisc ） in the reduction of corneal endothelial cells damage during cataract surgery. Methods 90 eyes of 80 age-related cataract patients from October, 2006 to June, 2007 were studied retrospectively. The patients were assigned to two groups based on which ophthalmic viscoelastic devices （OVD） used during surgery： DuoVisc and sodium hyaluronate with 45 eyes in each group. All patients were operated on the same surgery technique except the OVD. The visual acuity, corneal endothelial cell density （CD）, average cell area of endothelium （AVE）, percentage of hexagonal cells （ 6A ） and the central corneal thickness were measured preoperatively and 1 day, 1 month, and 3 months postoperatively, respectively. Results Preoperatively, no significance difference was observed in endothelial count, AVE, hexagonal cell pattern and pachymetry be- tween two groups. All two groups showed a significant decrease in cell count with a more significantly less in the sodium hyaluronate group （P〈0.05 ） at the 1 day, 1 month and 3 months, as well as a significantly increase of the AVE in the sodium hyaluronate group as comparing to that of the DuoVisc group （P〈0.05 ）, postoperatively. The increase of central corneal thickness was statistically significant between two groups （P〈0.05 ） at 1 day and 1 month, postoperatively. There was no significant change of pachymetry between two groups at 3 months （P〉0.05 ）, postoperatively. The visual acuity of both groups presented an equal and significant increase （P〈0.05 ）. Conclusions By combination of cohesive and dispersive ophthalmic viscoelastic devices, the soft-shell technique provide a better protection of corneal endothelial cells during phacoemulsification.

关 键 词：软壳技术 超声乳化手术 黏弹剂 角膜内皮 

分 类 号：R779.65[医药卫生—眼科] R779.66[医药卫生—临床医学]