经角膜缘切口取出眼内硅油对角膜内皮的影响  

The evaluation of endothelial influence in the silicone oil removal surgery by limbus incision

作　　者：周李 刘文 黄学文 黄海 

机构地区：[1]南充市中心医院眼科,四川省南充市637000

出　　处：《中国实用眼科杂志》2013年第1期75-79,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨南角膜缘切15取出眼内硅油对角膜内皮的影响及该方法的手术效果。方法表面麻醉下，用20G巩膜穿刺刀从颞下和12点角膜缘做两个长约1mm隧道穿刺孔进入前房。灌注针头自颞下方角膜缘隧道切口插入前房进行灌注；20G静脉穿刺套管经12点位角膜缘隧道切口插入前房，手动抽吸出全部硅油，再行气／液交换3次。同顾性分析接受该手术方法的硅油填充眼23只眼（无晶体眼19只眼，伴白内障5只眼）。记录手术时间，术前和术后第一天角膜内皮计数、角膜厚度、视力、眼压等。术后随访记录视力、眼压和视网膜情况。结果23只眼均一次性取净硅油。单纯取硅油时问为（27．18±9．30）min。术前角膜厚平均（521．8±37．9）μm，术后为（540．2±42．7）μm（t=-2．18，P=0．04）。手术后较术前角前膜内皮细胞减少了（245．4＋353．6）／mm。（t=3．33P=0．00）。术后角膜平均细胞面积增加（t=-2．78，P=0．01）。六角形细胞数和细胞形态变异系数未发现术前术后差异有统计学意义（t=1．39P=0．18；t=-1．38，P=O．18）。术后结膜、角膜和前房炎症反应轻微。术后第1天较术前视力提高有14只眼，无变化5只眼，降低4只眼。术后视力与术前比较差异有统计学意义（Wilcoxon法，P=0．04）。随访3～40mon平均（15．32＋11．62）mon未发现视网膜脱离复发。结论无品状体眼由角膜缘隧道切口代替巩膜切口取出眼内硅油对角膜内皮有一定影响；但角膜内皮无明显异常者是可耐受的。该方法简便省时和安全，适用于无品状体及需同时摘除白内障的硅油填充眼。术前角膜内皮计数低于1000个／mm2者，术前视网膜未平或屈光介质不清影响眼底观察者不适用于该方法。Objective To investigate the influence on corneal endotheliocytes and its indication of the silicone oil removal surgery with limbus incision. Methods 20G scleral puncture knife, from temporal and 12：00 limbus under topical anesthesia, punctured two about lmm tunnels into the anteri- or chamber. Infusion needle was inserted from the temporal limbus tunnel incision into the anterior chamber. 20G veinpuncture casing got into the anterior chamber from 12：00 limbal tunnel incision. Manually pumped out all the silicone oil and then gas/liquid exchanged three times. The silicone oil-filled 23 eyes were analyzed, including 19 phakic and 5 with cataract, accepted such surgeries ret- rospectively. The timing of the operation, corneal endothelial counting, corneal thickness, vision, and intraocular pressure were recorded on the preoperative and postoperative first day. When followed up for 3-40 months （mean 15.32±11.62 mort）, the eyesight, intraocular pressure and retina were ob- served. Results Twenty-three cases were extracted successfully once. Silicone oil removal took 27.18±9.30 min. After surgery the cell density of corneal endotheliocytes lost 245.4±353.6/mm2 on av- erage （t =3.33 P =0.00）. Postoperative corneal thickness increased （t =-2.18, P =0.04）. The average size of cornea cell rose after surgery （t =-2.78, P =0.01）, The changes of Hexagonality and CV of size seemed no statistical differences （t =1.39 P =0.18; t =-1.38, P =0.18）. One day alter surgery vi- sual acuity improved in 14 eyes, unchanged 5 eyes, reducing 4 eyes （Wilcoxon method, P =0.04）. In the follow-up 3-40 months （average 15.32±11.62 mon）, there was no recurrent retinal detachment. Conclusions Removal of intraocu[ar silicone oil has a certain influence on the corneal endothelium in aphakic eyes by limbal tunnel incision instead scleral incision; but in normal corneal endothelial eyes it can be tolerated. This method is simple, time-saving and safety. And it is suitable for the aphakic and the need for removal

关 键 词：玻璃体手术 硅油 无晶体眼 角膜内皮 

分 类 号：R779.6[医药卫生—眼科]