Fuchs角膜内皮营养不良患者白内障手术疗效分析

Surgery for treatment of senile cataract with Fuchs′endothelial dystrophy

目的 评价Fuchs角膜内皮营养不良 (FED)患者行白内障摘除人工晶状体植入术的临床效果。方法 对连续的 2 0 2 6例 (2 0 2 6只眼 )老年性白内障患者行白内障摘除人工晶状体植入术 ,其中术前行角膜内皮细胞检查确诊为FED患者 1 7例 (1 7只眼 ) ,记录手术方式、术中保护角膜内皮细胞的方法 ,观察手术前、后角膜内皮细胞的变化 ,以及术后视力和角膜状况。结果 老年性白内障患者中FED的发生率为 0 8% (1 7 2 0 2 6)。白内障摘除人工晶状体植入术后角膜内皮细胞的丢失率为1 6 2 % (32 4 1 998)。 94 1 % (1 6 1 7)患者术后最佳矫正视力≥ 0 5。随访时间 6～ 36个月 ,无角膜内皮功能失代偿者。结论 白内障摘除术前对老年性白内障患者进行角膜内皮细胞检查具有十分重要的临床意义 ;白内障摘除术中对FED患者的角膜采取保护措施和由技术熟练的术者完成手术 ,是手术获得满意疗效的重要保证。

Objective To evaluate the result of surgery for senile cataract with Fuchs′ endothelial dystrophy and emphasize the importance of the preoperative examination by specular microscopy.Methods In the review of 2 026 consecutive senile cataract cases, 17 Fuchs′ endothelial dystrophy cases were found before cataract surgery by specular microscopy. Operative procedures and corneal endothelial protective measures were recorded, and postoperative corneal transparency was observed. The examination of specular microscopy was performed 3 months after the cataract surgery.Results The incidence of Fuchs′ endothelial dystrophy in senile cataract was 0.8%(17/2 026)in our study. The loss rate of endothelial cells was 16 2%. No bullous keratopathy occurred in all cases during follow up period.Conclusions Reasonable measures to protect the endothelium in the surgery by an experienced operator is helpful to the success of surgery. Observing the endothelium by specular microscopy before cataract surgery is very important.