23G玻璃体切割术对糖尿病玻璃体视网膜病变患者角膜内皮细胞的影响  

Changes of corneal endothelium cells following 23 gauge vitrectomy in diabetic retinopathy patients

作　　者：周贤慧[1] 孟旭霞[1] 

机构地区：[1]青岛大学附属医院眼科,266500

出　　处：《中华实验眼科杂志》2015年第5期456-460,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 23G玻璃体切割术已广泛用于糖尿病视网膜病变（DR）患者的手术治疗,了解23G玻璃体切割术对术眼角膜内皮细胞的影响具有重要的临床意义. 目的 观察23G玻璃体切割术对有晶状体眼的DR患者角膜内皮细胞的影响. 方法 采用回顾性研究方法.纳入2012年8月至2013年6月在青岛大学附属医院眼科拟行玻璃体切割术的玻璃体视网膜病变患者124例124眼,根据患者是否罹患DR分为2个组,其中DR组52例52眼,非DR组72例72眼,所有患者均行23G玻璃体切割术.术前及术后1d、3d、1周、2周、1个月、3个月采用SP-3000P角膜内皮镜检查术眼角膜内皮,观察并记录DR组和非DR组术眼在不同时间点角膜内皮细胞密度、内皮细胞面积变异系数（CV）、内皮平均细胞面积标准差（SD）、角膜内皮六角形细胞比率及角膜厚度（CT）变化.结果 DR组与非DR组在手术前后不同时间点中央角膜内皮细胞密度的变化差异均无统计学意义（F分组=2.148,P=0.150;F时间=0.900,P=0.504）;DR组术眼术后1d角膜内皮细胞CV、内皮平均细胞面积SD及CT均明显高于术前值,差异均有统计学意义（P=0.000、0.011、0.033）,而角膜内皮六角形细胞比率低于术前值,差异有统计学意义（P=0.001）,但术后1个月角膜内皮细胞CV和角膜内皮六角形细胞比率恢复至术前水平.非DR组术眼术后1d角膜内皮细胞CV及CT明显高于术前值,差异均有统计学意义（P=0.002、0.003）,而角膜内皮六角形细胞比率较术前明显下降,差异有统计学意义（P=0.000）,并于术后1周恢复至术前水平. 结论 23G玻璃体切割术对有晶状体眼的DR视网膜病变患者角膜内皮细胞的影响主要在于细胞形态学方面的可逆性改变,DR患者术后角膜内皮细胞形态学变异更明显,较非DR患者恢复时间更长.Background 23G pars plana vitrectomy has been widely applied to treat diabetic retinopathy （OR）.Researching the influence of 23G pars plana vitrectomy on corneal endothelium cell has a great clinical significance.Objective To observe the influence of 23G pars plana vitrectomy on corneal endothelial cells in phakic eyes of diabetes and non-diabetes patients.Methods A retrospective study was designed.One hundred and twenty-four eyes of 124 patients with vitreoretinopathy were included in Affiliated Hospital of Qingdao University from August 2012 to June 2013.The patients were assigned to DR group （52 eyes） and non-DR group （72 eyes）.23G pars plana vitrectomy was performed on all the patients under their informed consent.Endothelial cell density,corneal thickness（CT）,coefficient of variation （CV） of cellular area,standard deviation （SD） of average cellular area and percentage of hexagonal endothelial cells were measured before and 1 day,3 days,1 week,2 week,1 month and 3 months after surgery with Topcon SP-3000P corneal specular microscope.Results No significant differences were found in the central corneal endothelial cell density between the DR group and non-DR group at various time points （Fgroup =2.148,P=0.150;Ftime =0.900,P=0.504）.The CV of endothelial cells,SD of endothelial cellular area and CT in the first day after surgery were higher than preoperation （P =0.000,0.011,0.033）,while the percentage of hexagonal endothelial cells was declined （P =0.001）.The CV of endothelial cells and the percentage of hexagonal endothelial cells recovered in postoperative 1 month in the DR group.In the non-DR group,the CV of endothelial cells and CT elevated in postoperative 1 day in comparison with preoperation （P =0.002,0.003）,and the percentage of hexagonal endothelial cells reduced （P =0.000）.These abnormalities returned to a preoperative level in a week after surgery.Conclusions 23G pars plana vitrectomy results in a reversible morphology damage of corneal endothelial cells.Thes

关 键 词：玻璃体切割术/并发症 角膜内皮细胞 糖尿病视网膜病变/手术 回顾性研究 

分 类 号：R779.6[医药卫生—眼科]