Fuchs角膜内皮营养不良合并高度近视患者的白内障手术疗效观察  

Cataract surgery in patients with Fuchs endothelial corneal dystrophy and high myopia

作　　者：龚莹莹[1] 陈孝霞[1] 辜臻晟[1] 

机构地区：[1]上海交通大学医学院附属新华医院眼科,上海200092

出　　处：《上海交通大学学报（医学版）》2017年第10期1393-1397,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·观察Fuchs角膜内皮营养不良(FECD)合并高度近视患者行白内障超声乳化吸除联合人工晶状体(IOL)植入术的手术效果与安全性。方法·回顾性对2015年1月至2016年2月在上海交通大学医学院附属新华医院眼科通过角膜共聚焦显微镜检查确诊为FECD,且合并高度近视及白内障的5例患者(9眼)进行研究。患者均行白内障超声乳化吸除联合IOL植入术。观察手术前后视力、眼压、角膜内皮细胞密度(CD)、中央角膜厚度(CCT)的变化等情况。采用配对t检验行统计学分析。结果·9眼中有8眼术后最佳矫正视力至少提高2行,有4眼达到0.6以上。手术前后眼压比较差异无统计学意义(t=-1.066,P=0.318)。手术前后CD分别为(2 184.25±196.44)个/mm^2和(1 910.0±83.41)个/mm^2,差异无统计学意义(t=2.876,P=0.064)。角膜内皮细胞丢失率为(12.10±7.84)%。手术前后CCT分别为(546.83±33.74)μm和(566.67±24.66)μm,差异无统计学意义(t=1.971,P=0.106)。有1眼术前术后CD测不出,术后视力无改善,且角膜基质混浊水肿明显,后行穿透性角膜移植术。结论·FECD合并高度近视患者行白内障超声乳化吸除联合IOL植入术是安全、有效的。术前需准确评估角膜内皮状况和预后,术中采取必要措施尽量减少内皮细胞损伤以保证疗效。Objective · To evaluate the effect of phacoemulsification combining with intraocular lens （IOL） implantation in cataract patients with Fuchs endothelial corneal dystrophy （FECD） and high myopia. Methods · Five patients （9 eyes） diagnosed with FECD and high myopia were collected retrospectively at Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to February 2016. All the 9 eyes underwent phacoemulsification combining with IOL implantation. Visual acuity, intraocular pressure, corneal endothelial cell density （CD） and central corneal thickness （CCT） were evaluated. Paired t-test was performed to evaluate the differences. Results · 88.89% （8/9） of the vision of the patients was improved, the best corrected visual acuity improved at least 2 lines. The intraocular pressure had no statistically significant difference before and after the operation （t=-1.066, P=0.318）. The preoperative and postoperative CDs were （2 184.25±196.44） cells/mm^2 and （1 910.0±83.41） cells/mm^2 （t=2.876, P=0.064）. The preoperative and postoperative CCTs were （546.83±33.74） μm and （566.67±24.66） μm （t=1.971, P=0.106）. The loss rate for endothelial cells was （12.10±7.84）%. Only one patient was observed corneal edema and the CD could not be determined, so he underwent penetrating keratoplasty. Conclusion · Phacoemulsification combining with IOL implantation is safe and effective for patients with FECD and high myopia. Preoperative evaluation of corneal endothelium is necessary. Some measures should be taken into consideration to reduce the loss of endothelial cells during in surgery.

关 键 词：Fuchs角膜内皮营养不良 高度近视 白内障 白内障超声乳化术 

分 类 号：R779.66[医药卫生—眼科]