穿透性角膜移植术后高危白内障的手术选择和临床结果分析

Evaluation of surgical methods selection and clinical results of high-risk cataract surgeries after keratoplasty

目的 对穿透性角膜移植术后角膜内皮细胞数目低于 12 0 0 /mm2 的高危白内障患者的白内障摘除方法和临床结果进行分析。方法 对 18例穿透性角膜移植术后角膜内皮细胞数目低于12 0 0 /mm2 的白内障患者 ,根据其晶体核的分级 ,分别采取白内障超声乳化摘除术联合人工晶体植入术或白内障囊外摘除术联合人工晶体植入术。术前和术后进行角膜内皮照相 ,内皮细胞计数。结果 18例患者术后裸眼视力范围 0 1～ 0 8,最佳矫正视力 0 1～ 1 0。经过 3～ 3 1个月的随访 ,无 1例发生大泡性角膜病变。结论 对穿透性角膜移植术后白内障患者 ,当其角膜内皮细胞数目为 60 0～ 12 0 0 /mm2 时 ,在选择白内障手术方法时 ,应根据术者的白内障手术经验 ,以及白内障晶体核的硬度分别采取白内障超声乳化摘除术联合人工晶体植入术或白内障囊外摘除术联合人工晶体植入术。在手术时注意使用粘弹剂保护角膜内皮 ,超声乳化时采取拦截劈核法 ,将核劈为 6～ 8块 ,可有效节省术中使用的超声能量 ,减少对角膜内皮细胞的损伤 ,只要保护措施得当 。

Objective Evaluation of cataract extraction menthods and clinical results of post-keratoplasty high-risk cataract with endothelial cells less than 1200/mm 2.Methods According to hardness of cataract,phacoemulsification or planned extracapsular cataract extraction were performed with intraocular lens implantation in 18 eyes which endothelial cells were less than 1200/mm 2 after penetrating keratoplasty.Specular photography was performed preoperatively and 3 months postoperatively.Results Post-operative visual acuity was ranged from 0 1～0 8,the best corrected VA was ranged from 0 1～1 0.After an average 11 months(3～31month)follow-up,bullous keratopathy was not observed.Conclusions To those post-keratoplasty cataract patients with corneal endothilial cells ranged from 600～1200/mm 2,acoording to the hardness of cataract,phacoemulsification or planned extracapsular cataract extraction and intraocular lens implantation were performed.The technique of stop&chop was used,the nucleus was divided into 6～8 pieces,the actual phaco power was reduced and loss of endothelial cells decreased.With careful protection measures during operation,the satisfied clinical results can be obtained even to these high-risk patients.