白内障超声乳化术前及术中参数对角膜内皮的影响  

Effect of preoperative and intraoperative parameters on corneal endothelial cell damage after phacoemulsification

作　　者：陈月芹[1] 薛春燕[1] 陈银[1] 朱婷[1] 叶芬[1] 胡钦瑞[1] 黄振平[1] 

机构地区：[1]南京大学医学院临床学院（南京军区南京总医院）眼科,江苏省南京市210002

出　　处：《中国实用眼科杂志》2012年第3期270-272,共3页Chinese Journal of Practical Ophthalmology

基　　金：南京军区医药卫生科研基金（07M086）通信作者：黄振平,Email：[e-mail]

摘　　要：目的评估白内障超声乳化手术的一些术前以及术中参数对术后角膜内皮损伤的影响。方法83例患者（100只眼）行白内障超声乳化手术。术前、术中记录患者年龄、核硬度、前房深度（ACD）、眼轴长度、切口累计消散能量（CDE）、注吸时间以及液流量。术前以及术后2周测量患者中央角膜内皮细胞密度（CED）、细胞变异度（CV）、平均细胞面积（AVG）、六边形细胞比率。结果术后2周，角膜内皮细胞平均丢失（377．14±283．00）／mm2，丢失率为（14．37±10．59）％，术前、术后内皮细胞密度差异有统计学意义（P〈0．001）。术后角膜内皮形态发生改变，六边形细胞比率减少，术前、术后患者的CV、AVG、六边形细胞比率差别有统计学意义（P〈0．001）。内皮细胞丢失量与核硬度、超声能量、前房深度、年龄有一定的相关性（分别为P〈0．001，P=0．008，P=0．005，P=0．035），但与液流量、注吸时间、眼轴长度无相关（分别为P=0．420，P=0．607，P=0．823）。结论白内障超声乳化手术后内皮细胞损伤的因素是多方面的，例如：核硬度、超声能量、前房深度等。应该提高手术技巧以及手术设备减轻对角膜内皮的损伤。Objective To evaluate the effect of preoperative and intraoperative parameters on cor- neal endothelial cell loss after phacoemulsification. Methods Eighty-three patients （100 eyes） sched- uled for phacoemulsification were selected for this clinical trial. The main preoperative and intraopera- tive parameters evaluated were age, density of the nucleus, anterior chember depth （ACD）, axial length, cummulative dissipated energy （CDE）, irrigation time, and irrigation volume. Before and 2 weeks after surgery, the central corneal endothelial cell density （CED）, coefficient of variation of cell size （CV）, average cell size （AVG） and hexagonality were assessed. Results Two weeks after surgery, the mean corneal endothelial cell lost 377.14 ：L283.00 /mm2, with the rate of 14.37~10.59%, and the difference of CED before and after surgery was significant （P 〈0.001）. After surgery, the variation of cell size had been obseved with the hexagon cell percentage decreased, and the differ- ence in CV, AVG and hexagonality before and after surgery was significant （P 〈0.001）, There were relationships between nuclear density, phaco power, ACD, age and endothelial cell loss （P 〈0.001, P =0.008, P =0.005, P =0.035, respectively）; however, total fluid volume, irrigation time and axial length were not significant predictors （P =0.420, P =0.607, P =0.823, respectively）. Conclusions Phacoemulsification on corneal endothelial cell loss involves in many factors, such as nuclear density, phaco power and ACD. And the surgical skills and equipments should be improved to reduce the corneal endothelial damage.

关 键 词：角膜内皮细胞 超声乳化手术 超声能量 前房深度 

分 类 号：R779.66[医药卫生—眼科]