外伤性无晶体眼二期人工晶体植入术前后角膜内皮的改变

Changes of corneal endothelium after secondary intraocular lens implantation of traumatic aphakia

目的了解外伤性无晶体眼患者角膜内皮的分布特点及二期人工晶体植入术对角膜内皮的影响。方法2004年12月至2005年5月于中山眼科中心外伤科2组的所有行二期人工晶体植入术的患者纳入本研究。测量患者术前术后角膜5个方位的角膜内皮细胞密度。比较术前术后角膜内皮细胞的变化。结果21例患者纳入研究,11例行上方角巩膜缘植入PMMA人工晶体,10例行在平坦部玻璃体腔内灌注下经上方角巩膜缘植入PMMA人工晶体缝襻固定术。术前伤口附近及上方角膜比其他位置的角膜的内皮细胞密度分别低417.8个/mm2及141.0个/mm2。二期人工晶体植入术后1周角膜内皮损失约129.2个/mm2,术后1个月比术后1周角膜内皮密度进一步下降。有眼内灌注及缝襻固定比无眼内灌注无缝襻固定的患者术后多丢失的角膜内皮数目大概为124个/mm2。术前角膜内皮细胞密度差异大,手术丢失的角膜内皮细胞的数目与术前角膜内皮细胞密度呈反比。结论多点测量角膜内皮为二期人工晶体植入术提供更客观全面的依据。手术丢失的角膜内皮细胞数目与术前角膜内皮细胞数目呈负相关。人工晶体手术切口应避免角膜穿通口位置。

Purpose To find out the changes of corneal endothelium after secondary intraocular lens implantation for posttraumatic aphakia. Methods Twenty-four patients with traumatic aphakia were included in this study. Photographs were taken at 5 points area of cornea. Endothelial density was measured before and after the operation. Results Twenty-one patients were included in this study. Eleven patients underwent the operation of PMMA lens implantation through superior corneoscleral incision, while ten patients underwent the operation of transcleral fixation of PMMA intraocular lens with intraocular infusion. The endothelial cell density near the corneal wound and superior cornea was significantly lower than that of other paracentral cornea. About 129.2 cells/mm^2 loss one week after the operation, and about 114.Scellsdmm^2 loss between the interval of one week and one month postoperatively. More 124 cells/mm^2 loss in group of transcleral fixation Of PMMA lens with intraocular infusion compared with the group of PMMA lens intraocular implantation without fixation and infusion. Cell loss during the surgery was negatively correlated to the preoperative cell density. Conclusions Corneal endothelial cell loss during the secondary intraocular implantation is negatively correlated to the preoperative cell density. And the incision should deviate from the site of corneal penetrating wound. Multiple points measurement of corneal endothelium density is recommended in posttraumatic aphakia preoperatively. The preoperative ECD should be larger than 1120cells/mm^2 in patients who will undergo secondary lens implantation; and 1220cells/mm^2 in patients who will undergo lens implantation with sulcus fixation and intraocular irrigation.