角膜内皮面硅油的形态学观察及定量分析

Morphologic observation and quantitative analysis of silicone oil in contact with corneal endothelium

目的观察贴附在角膜内皮面的硅油形态学变化及对角膜内皮细胞损害的形态学进行定量分析。方法选择已行经睫状体平部玻璃体手术联合硅油玻璃体腔内注射手术后1周～1年并出现硅油进入前房且已贴附在内皮面的患者11例(11眼,有晶体眼),应用角膜内皮细胞分析系统(角膜内皮镜)观察进入前房并已贴附在内皮面的硅油,手术取出前后角膜内皮细胞形态学的改变及形态定量指标的变化。结果硅油取出术前角膜内皮镜检查,镜下清晰可见贴附在内皮面的硅油液面与内皮细胞层紧密黏贴,并形成特殊的明亮反光,内皮细胞边界发亮(即“亮度颠倒”现象),在角膜后表面皱褶的边缘有亮暗相间的轮廓线;角膜内皮细胞4项形态定量指标中:细胞面积和细胞密度两项手术前后(术后4～7d)改变无统计学差异,六棱细胞比率和变异系数两项改变有统计学差异。结论角膜内皮面贴附硅油时,出现特有的角膜内皮镜下改变,且在短期内即可直接损害内皮细胞,应尽早取出。提示医师在玻璃体手术联合硅油玻璃体腔内注射时需选择纯度及黏滞度,以及控制硅油的注入量。

Objective To assess the disadvantages of silicone oil for corneal endothelium cell by observing the morphologic and quantitative indexes changes of silicone oil in contact with corneal endothelium of entrying into the anterior chamber. Methods Eleven patients (11 eyes, intraocular lens ) who had been operated in pars plana vitrectomy associated with silicone oil injected before at least 1 week were found with silicone oil in contact with corneal endothelium into the anterior chamber. Before and after extraction of silicone oil, all patients were examined with specular microscopy for quantitative analysis. Results The preoperative specular microscopy showed that the optical characteristics of silicone oil in contact with corneal endothelium was bright reflection, reverses luminance at the cell boundaries, and black and white contours at the margins of posterior corneal folds; preoperative and postoperative four quantitative indexes changes demonstrated that no significant difference appeared in cellular area and cellular density, but a significant difference in hexagonal cell and CV. Conclusion The special specular microscopy changes when silicone oil is contacted with corneal endothelium. The corneal endothelium can be damaged by silione-oil directly in a short time. It should be noticed to select the purity and centipoises of silicone oil and control the mount of silicone oil.