超声乳化吸除联合人工晶体植入治疗穿透性角膜移植术后白内障  

Treatment of phacoemulsification with IOL implantation in post-PKP cataract

作　　者：陈梅珠[1] 王云鹏[1] 郑祥榕[1] 陈国苍[1] 

机构地区：[1]福州总医院眼科

出　　处：《福州总医院学报》2010年第3期146-147,197,共3页Journal of Fuzhou General Hospital

摘　　要：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3个月以上3眼,余1例为排斥反应控制不到2个月。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,晶体核III-IV级。手术方式为超声乳化吸除联合人工晶体植入术,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1.5min-2.5min(1.95±0.47min)。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。术后第2天-第3天,角膜植片少许内皮皱褶,术后第4天角膜恢复透明。术前术后角膜移植片中央部位内皮细胞计数分别为:607-1998/mm2(1248.09±408.52/mm2)和601-1899/mm2(1184.36±373.92mm2),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=0.0045<0.05,有统计学意义。随访3个月以上,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。Objective： To analyse the factors of endothelial cell loss after cataract phacoemulsification with intraoculax lens implantation after PKP （penetrating keratoplasty） . Method： There were 11 eyes of post - PKP cataract. Immunological rejections were not observed in 7 of which, and 3 of which were found rejections but were controlled after treatment more than 3 months, i of which was found rejection but were controlled within 2 months. Visual acuity before cataract surgery were light perception - - 0.1, Endothelial cells density were measured before and after cataract surgery respectively. Corneal - scleral tunnel - llke incision was chosen under peribulbar anesthesia. Phacoemulsification were performed and injectable AMO Sensar IOL were implanted in capsular bag. The procedure were smoothly in all patients. Phaco time were 1.5rain - 2.5rain （ 1.95 ± 0.47 min）, and U/S power were 14.82 ± 0.47%, Asprate 26ml,/min, vaccum 180 - 200mmHg （U/S Power） and 200 - 210mmHg （U/S pulse） . Antibiotic and steroid eye drops were topically used after operation. Results ： The best - corrected visual acuity were 0.2 - 0.5, improved in all patients.＇ Endothelial cells density of pre - cataract and post- cataract were 607 - 1998/mm^2 （1248.09 ± 408.52/mm^2） and 601 - 1899/mm^2 （1184.36 ± 373.92 mm^2） respectively. The endothelial cell loss rate was 5.11% . There are statistically difference between pre - cataract and post - cataract （ T = 3. 6418, P = 0. 0045 〈 0.05） . No buUous keratopathy were observed. The corneal grafts were trnasparent after more than 3 months of follow- up. Conclusion： Phacoemulsification is safe and effective in post- PKP cataract.

关 键 词：角膜移植 白内障 超声乳化 角膜内皮 

分 类 号：R776.1[医药卫生—眼科]