超声乳化白内障吸除术后角膜内皮细胞损伤和修复的研究  

Corneal endothelial damage and its repair after phacoemulsification

作　　者：谢立信[1] 姚瞻[1] 黄钰森[1] 应良[1] 

机构地区：[1]山东省眼科研究所,青岛266071

出　　处：《中华眼科杂志》2004年第2期90-93,共4页Chinese Journal of Ophthalmology

摘　　要：目的　探讨超声乳化白内障吸除术后角膜内皮细胞损伤和修复的特点及角膜水肿的临床分级标准。方法　对 10 5例 (10 5只眼 )老年性白内障患者行超声乳化白内障吸除术 ,术后使用裂隙灯显微镜观察角膜水肿程度 ,并记录水肿消退时间 ;术前和术后 3个月分别使用接触型角膜内皮显微镜观察角膜上、中、下部内皮细胞的密度变化。结果　角膜水肿程度为 0～ 4级者的角膜内皮细胞丢失率分别为 4 6 %、14 9%、4 0 8%、6 7 0 %及 84 4 % ;1～ 3级者角膜水肿的消退时间分别为(2 1± 0 7)、(5 6± 1 9)、(2 1 8± 7 1)d。术后 3个月角膜上、中、下部内皮细胞平均密度分别为(2 0 0 6± 5 4 6 )、(1979± 5 4 5 )、(175 4± 5 4 3)个 /mm2 ;上部与下部、中部与下部比较 ,差异均有显著意义(P =0 0 2 5 ,0 0 30 ) ;上部与中部比较 ,差异无显著意义 (P =0 92 1)。角膜上、中、下部内皮细胞密度的平均下降值分别为 (6 2 7± 4 96 )、(6 5 6± 4 92 )、(10 2 6± 5 0 9)个 /mm2 ;上部与下部、中部与下部比较 ,差异均有显著意义 (P =0 0 17,0 0 2 7) ;上部与中部比较 ,差异无显著意义 (P =0 86 7)。结论　将超声乳化白内障吸除术后角膜水肿程度分为 0～ 4级 ,可明确表示角膜内皮细胞的损伤程度 ,为临床评估预后提?Objective To introduce a grading system for corneal edema after phacoemulsification and to study the corneal endothelial damage and its repair after phacoemulsification. Methods One hundred and five senile cataracts after phacoemulsification were included. Corneal edema was categorized into grades 0 to 4. Endothelial densities at various locations of the cornea were measured with specular microscopy before and three months after surgery. Results The corneal endothelial cell loss rate was 4.6%, 14.9%, 40.8%, 67.0% and 84.4% in eyes with corneal edema from grades 0 to 4, respectively. Time required for resolution of corneal edema was (2.1 ± 0.7)days (grade 1), (5.6 ± 1.9)days (grade 2) and (21.8 ± 7.1)days (grade 3). The endothelial cell densities at superior, mid and inferior portions of the cornea were (2006 ± 546)cells/mm2, (1979 ± 545)cells/mm2 and (1754 ± 543)cells/mm2 respectively at 3 months after phacoemulsification. Postoperative endothelial cell loss at superior, mid and inferior portions of the cornea was (627 ± 496)cells/mm2, (656 ± 492)cells/mm2 and (1026 ± 509)cells/mm2 respectively. The difference in postoperative endothelial cell densities between the superior and inferior portions of the cornea was statistically significant (P=0.017), so was the difference between mid and inferior portions of the corneas (P=0.027). There was no statistically significant difference between the superior and mid portions of the cornea (P=0.867). Conclusion The grading system for corneal edema is helpful in evaluating the severity of endothelial damage after phacoemulsification and can be used to predict the outcome of the cornea. The major area of endothelial injury after phacoemulsification occurs at the inferior portion of the cornea.

关 键 词：超声乳化吸除术 角膜内皮细胞损伤 修复 白内障 术后并发症 角膜水肿 

分 类 号：R779.66[医药卫生—眼科]