不同年龄角膜内皮对白内障手术敏感性研究

The Sensitivity of Human Corneal Endothelium in Different Ages to ECCE

目的 用角膜内皮显微镜观察细胞密度,探讨不同年龄角膜内皮细胞对现代白内障囊外摘除(ECCE)人工晶体植入术的不同反应。方法 把老年性、并发性、外伤性和先天性白内障共81例(100只眼)随机分为青年、中年和老年组。分别在术前、术后1-2周、2-3个月及6-12个月使用宽视野角膜内皮显微镜测定细胞密度,并对不同年龄组的计量资料差异进行统计学分析。结果 青年、中年和老年组术后6-12个月的内皮细胞丧失率分另4为8.67％、12.79％及17.11％。经统计学处理后有显著性差异(P<0.05)。结论 ①不同年龄角膜内皮细胞对ECCE的敏感性有差异,年龄越大,术后细胞丧失率越高,即年龄越大对手术创伤的敏感性越大,损伤越严重。②80岁以上白内障患者术后6-12个月内皮细胞丧失率为19.28％m,CV值为72.59％,提示:对高龄患者术前应作角膜内皮检查。若密度在1000个/mm^2以下以及其它指标较差,一般不宜施术。若为解除失明之苦一定要施术,则应对手术技巧及其它条件如粘稠剂、灌注液及人工晶体等作优质选择。

Objective TO observe the cell density with advanced wide-field speeula microscope, evaluate the corneal endothelial sensitivity of different ages which underwent the extracapsular cataract extraction (ECCE). Methods 81 patients (100 eyes) undergone ECCE with posterior chamber lens implantation were divided into three groups (the younger, the adult and the elder) at random, observed and analyzed with advanced specula microscopy before operation and 1-2 weeks, 2-3 months, 6-12 months after operation. The comeal endothelium density were recorded and analyzed. All data were tested by T-test from SPSS 8.0 for windows. ResultsThe lost rates of the corneal endothelium of the younger, the adult and the elder group were 8.67%, 17.79% and 17.11% respectively (P<0.05). The results showed that the elder of the age, the higher of the lost rate by 6-12 months after surgery. Conclusion ① The corneal endothelium of different ages have different sensitivity to ECCE. The elder of the age, the higher of the cell lost rate, which means the elders are more sensitive to the operation, the surgical injury is severer in the elders than in the younger. ②6-12 months after operation, in those cataract patients who are over 80 years old, the endothelium lost rate were 19.28%. It suggested that the corneal endothelium of those very old patients should be measured before operation. If the corneal endothelial density less than 1000cell/mm^2 and the other measure values were not satisfied yet, the surgery should be stopped. If the surgery which could bring sight to the patients must be done, the operator must be skilled, the other conditions such as the viscoelastics substances,the irrigation-aspiration systems and the IOL must be the best.