白内障超声乳化手术角膜内皮变化情况及对术前风险评估的意义  

Changes of corneal endothelium during phacoemulsification for cataract and its significance for preoperative risk assessment

作　　者：秦章鹏 张芳[1] 杨晶[1] QIN Zhangpeng;ZHANG Fang;YANG Jing(Department Of Ophthalmology,Ji'an Central People's Hospital,Ji'an,Jiangxi,343000,China)

机构地区：[1]吉安市中心人民医院眼科,江西吉安343000

出　　处：《当代医学》2021年第32期20-22,共3页Contemporary Medicine

基　　金：吉安市科技计划项目(吉市科计字[2017]5号(6))。

摘　　要：目的探讨白内障超声乳化术对角膜内皮细胞的影响及对术前风险评估的意义。方法选取2018年10月至2019年10月于本院行超声乳化术联合人工晶状体植入术的白内障患者60例,于手术前后开展角膜内皮检查,观察其角膜内皮细胞改变情况。结果60例患者术后出现角膜水肿43例(角膜水肿1级20例,2级16例,3级7例,4级0例),无角膜水肿17例。不同角膜水肿等级术前角膜内皮细胞密度比较差异无统计学意义,术后1~3级角膜水肿患者角膜内皮细胞密度均明显下降(P<0.05),水肿消退时间逐渐延长。术后1周、术后1个月角膜内皮细胞直径、CV明显高于术前(P<0.05),细胞密度、6A%则明显低于术前(P<0.05)。术后1个月角膜内皮细胞直径、CV较术后1周时明显下降(P<0.05),细胞密度、6A%高于术后1周时水平(P<0.05)。结论白内障超声乳化手术会造成角膜内皮细胞损伤,引发角膜水肿,术后1周是角膜内皮细胞损伤及角膜水肿的关键期。3级及以下角膜水肿在术后1个月,中央角膜内皮细胞形态及密度开始改善,角膜水肿基本消退。围手术期加强对角膜内皮细胞及角膜水肿的监测,对评估手术风险,提高手术安全具有重要意义。Objective To investigate the effect of phacoemulsification for cataract on corneal endothelial cells and its significance in preoperative risk assessment.Methods A total of 60 cataract patients who underwent phacoemulsification combined with intraocular lens implantation in our hospital from October 2018 to October 2019 were selected.Corneal endothelial examinations were performed before and after the operation to observe the changes in corneal endothelial cells.Results 60 patients had corneal edema after surgery,43 cases had no corneal edema 20 cases of grade 1 corneal edema,16 cases of grade 2,7 cases of grade 3,and 0 cases of grade 4 corneal edema,and 17 cases of no corneal edema.There was no significant difference in corneal endothelial cell density between different corneal edema grades before operation.The corneal endothelial cell density of patients with grade 1-3 corneal edema after operation decreased significantly(P<0.05),and the time for edema to subside gradually prolonged.The corneal endothelial cell diameter and CV were significantly higher at 1 week and 1 month after the operation(P<0.05),and the cell density and 6A%were significantly lower than before the operation(P<0.05).The corneal endothelial cell diameter and CV decreased significantly at 1 month after operation(P<0.05),and the cell density and 6A%were higher than the level at 1 week after operation(P<0.05).Conclusion Phacoemulsification for cataract can cause corneal endothelial cell damage and cause corneal edema.One week after surgery is a critical period for corneal endothelial cell damage and corneal edema.Corneal edema of grade 3 and below began to improve in the morphology and density of central corneal endothelial cells at 1 month after the operation,and the corneal edema basically subsided.Strengthening the monitoring of corneal endothelial cells and corneal edema during the perioperative period is of great significance for assessing surgical risks and improving surgical safety.

关 键 词：白内障 超声乳化手术 角膜内皮细胞 风险评估 

分 类 号：R779.66[医药卫生—眼科]