应用共焦显微镜观察超声乳化术后角膜内皮层的形态学改变

Morphologic characteristics of corneal endothelium in cataract patients after phacoemulsification observed with confocal microscopy

目的应用共焦显微镜(CMTF)观察超声乳化手术(Phaco)后角膜内皮层的形态学改变特征。设计前瞻性、非对照干预研究。研究对象19例(22眼)老年性白内障行Phaeo术后患者。方法应用CMTF对由同一手术医师所行Phaco术的老年性白内障患者术前及术后1周、1个月、3个月和6个月中央角膜内皮细胞密度和内皮细胞层图像变化进行统计学分析和形态学比较。主要指标角膜内皮细胞密度和内皮细胞层CMTF形态。结果CMTF检查显示术后角膜内皮形态异形性升高,可见内皮细胞表面沉着物、内皮细胞水肿、缺失和类似假性内皮营养不良等表现;同时见到坏死细胞周围的内皮细胞呈火山口样隆起、细胞面积增大、伸出伪足填补缺失区等修复过程的表现。角膜内皮细胞密度术前平均为(2491±602),术后1周、1个月、3个月和6个月分别为(2112±640)、(2058±673)、(2129±711)、(2084±635),与术前比较有统计意义的下降(P均<0．05)。结论Phaco后角膜内皮的丢失为非再生性;内皮细胞损伤可表现为水肿、坏死后的丢失以及假性营养不良等表现;损伤的内皮细胞修复主要通过周围内皮细胞的移行填补过程完成。

Objective To investigate with confocal microscopy about the morphological changes of central corneal endothelia in healthy old people after phacoemulsification. Design Prospective, noncomparative, interventional case series. Participants 19 （22 eyes ） healthy age-related cataract patients. Methods The study was performed in patients who had been operated with phacoemulsification by the same ophthalmologist. Endothelial density and morphological changes in central cornea were examined with CMTF just before operation and on the day of 1 week, 1 month, 3 months and 6 months after operation. Main Outcome Measures Endothelial density and endothelial morphological images with CMTF. Results CMTF images reveal that the shape of endothelium is quite different after phacoemulsification. Keratic precipitation, endothelial edema, endothelial absent area and pseudognttata-like changes can be seen. Also, the resealing process of endothelium adjacent endothelial absent area can be observed. Before operation, the average endothelial density is 2491±602, while at the time points of 1 week, 1 month, 3 months and 6 months after operation it was 2112±640, 2058±673, 2129±711, 2084±635, respectively, which are significantly lower than that before operation （P〈0.05）. Conclusion Human corneal endothelial loss can＇t regenerate by mitosis; Endothelium injury after phacoemulsification can present as endothelial edema, endothelial absent area and pseudognttata-like changes. The area of endothelial absence can be resealed by the neighbor endothelia.