不同类型白内障囊外摘除术(ECCE)对核硬度≥Ⅳ级伴低角膜内皮细胞密度白内障患者的疗效分析  

Influence of different types of extra capsular cataract extraction on clinical efficacy and safety of≥hard grade 4 cataract patients with low corneal endothelial cell count

作　　者：申海翠 李佳[1] 张雪彤[1] 夏鑫 王继红 SHEN Haicui;LI Jia;ZHANG Xuetong;XIA Xin;WANG Jihong(Department of Ophthalmology,Affiliated Hospital of Jiangnan University,Wuxi 214000,Jiangsu Province,China)

机构地区：[1]江南大学附属医院眼科,江苏省无锡市214000

出　　处：《眼科新进展》2021年第3期250-253,共4页Recent Advances in Ophthalmology

摘　　要：目的对比并分析单切口和双切口白内障囊外摘除术(extra capsular cataract extraction,ECCE)对核硬度≥Ⅳ级伴低角膜内皮细胞密度白内障患者的疗效。方法回顾性分析我院2017年1月至2019年12月收治的晶状体核硬度≥Ⅳ级且角膜内皮细胞密度<1000个·mm^(-2)的白内障患者共92例94眼的临床资料,其中46例46眼采用双切口ECCE治疗设为A组,46例48眼采用单切口ECCE治疗设为B组。术后随访6个月,比较两组手术时间及手术前后患者视力、散光度、角膜内皮细胞密度、角膜内皮细胞丢失率、六边形细胞比例及并发症发生情况。结果两组患者术前基线资料、手术时间及术后视力、术后散光度、术源性散光度等相比,差异均无统计学意义(均为P>0.05)。术后6个月,A组角膜内皮细胞密度为(780.73±110.14)个·mm^(-2),显著多于B组的(706.15±84.07)个·mm^(-2),差异有统计学意义(P=0.00);A组角膜内皮细胞丢失率和六边形细胞比例分别为(4.08±0.52)%和(10.14±6.60)%,均显著少于B组的(10.89±1.40)%和(27.86±9.53)%,差异均有统计学意义(均为P=0.00)。随访期内,A组患者术后角膜水肿发生率为8.70%,显著低于B组患者的37.50%(P<0.05);A组未见大泡性角膜病变,角膜内皮细胞密度<600个·mm^(-2)者4眼;B组6眼出现大泡性角膜病变,未见角膜内皮细胞密度<600个·mm^(-2)者。结论相较于单切口ECCE,双切口ECCE治疗核硬度≥Ⅳ级伴低角膜内皮细胞密度白内障患者可有效保护角膜内皮细胞,降低术后早期角膜水肿发生风险,且两种手术方式整体疗效接近。Objective To investigate the influence of single and double incision of extra capsular cataract extraction(ECCE)on clinical efficacy and safety of≥hard grade 4 cataract patients with low corneal endothelial cell count.Methods Clinical data of 92 cataract patients with≥hard grade 4 and low corneal endothelial cell(low than 1000 cells·mm^(-2))were retrospectively chosen in our hospital in the period from January 2017 to December 2019,and divided into 2 groups including A group(46 patients for 46 eyes)with double incision of ECCE and B group(46 patients for 46 eyes)with single incision of ECCE.The baseline clinical data,operation time,and postoperative visual acuity,astigmatism,corneal endothelial cell density and loss rate,proportion of hexagonal cells and complications incidence of 2 groups were compared 6 months after operation.Results There were no significant difference in the baseline clinical data,the operation time,postoperative visual acuity and astigmatism between 2 groups(all P>0.05).Six months after operation,the number of corneal endothelial cells in group A(780.73±110.14)cells·mm^(-2) was significantly higher than that in group B(706.15±84.07)cells·mm^(-2)(P=0.000).The corneal endothelial cell loss rate and proportion of hexagonal cells after operation in group was(4.08±0.52)%and(10.14±6.60)%,respectively,which were significantly lower than those in group B(10.89±1.40)%and(27.86±9.53)%,respcetivrly(P<0.05).During the follow-up,the incidence of corneal edema in early postoperative period in group A(8.70%)was significantly lower than that in group B(37.50%)(P<0.05).No bullae keratopathy was observed in group A,and the density of corneal endothelial cells was less than 600·mm^(-2) in 4 eyes.Bulbal keratopathy was observed in 6 eyes of group B,and no patients with corneal endothelial cell density<600·mm^(-2) was observed.Conclusion Compared with single incision ECCE,double incision of ECCE in the treatment of≥hard grade 4 cataract patients with low corneal endothelial cell count can effect

关 键 词：双切口 白内障囊外摘除术 核硬度 白内障 角膜内皮细胞 

分 类 号：R776[医药卫生—眼科]