超声乳化术中3种黏弹剂对角膜内皮保护作用的比较

Comparison in the protective effects of three different viscoelastic substances on corneal endothelium in phacoemulsification

目的:观察超声乳化过程中,3种黏弹剂对角膜内皮细胞的保护作用。方法:实验于2003-06/2004-01在锦州医学院实验动物中心实验室和锦州市亚东眼科医院实验动物手术中心实验室进行。取纯种日本大耳白兔16只。随机抽出4只兔8只眼用于正常角膜内皮活性染色,其余按术中应用不同的黏弹剂分为3组:Viscoat组、AmviscPlus组和海诺特组。每组4只兔,每只兔双眼行超声乳化术,用接触性角膜内皮显微镜分别观察术前和术后6h角膜内皮细胞密度,并在术后6h经锥蓝-茜素红活性染色后,光镜下观察角膜内皮细胞形态结构的变化,同时计算内皮细胞存活率。结果:①角膜内皮细胞损失率:术后6h3组内皮细胞密度均低于术前(P<0.01),Viscoat组内皮细胞损失率低于AmviscPlus组和海诺特组(4.99±2.70)%,(8.22±1.52)%,(10.14±4.05)%,P<0.05),AmviscPlus组与海诺特组对比差异无显著性(P>0.05)。②内皮细胞存活率:术后6h,Viscoat组平均内皮细胞存活率高于AmviscPlus组和海诺特组[(93.78±3.14)%,(80.77±3.91)%,(84.91±6.71)%,P<0.01],AmviscPlus组与海诺特组比较差异无显著性(P>0.05)。③角膜内皮细胞形态结构特征:光镜显示Viscoat组角膜内皮细胞损害最小。结论:弥散性黏弹剂Viscoat对比其他粘弹性物质保护效果要好。

AIM： To observe the protective effect of 3 different viscoelastic substances on corneal endothelial cells during phacoemulsificetion. METHODS： The experiment was conducted in the Central Laboratory of Experimental Animals, Jinzhou Medical College and Central Laboratory of Experimental Animals, Yadong Ophthalmological Hospital from June 2003 to January 2004. Sixteen rabbits ware selected, from which eight corneas （four rabbits） ware randomly selected for normal vital staining of cemeal endothelium, while the others ware divided into 3 groups according to different viscoelastic substances：Viscoat group, AmvisC Plus group and Hal Nuote group with 4 rabbits in each group. The phacoemulsification was performed on both eyes of each rabbit, and the contact specular microscope was used to evaluate the endothelial cell density preoperatively and at 6 hours after operation. The changes in endothelial cells were examined under the light microscopy, meanwhile, survival rate of endothelial cells was calculated. RESULTS ：① The losing rate of corneal endothelial cells： The density of endothelial cells at 6 hours after the operation ware lower than that before the operation in three groups （P 〈 0,01 ）, and it was lower in the Viscoat group than that in the Amuisc group and Hal Nuote group [（4.99±2.70）%,（8.22±1.52）%,（10.14±4.05）%,P 〈 0.05], while there ware no significant differences in comparison between the Amvisc Plus group and the Hal Nuote group （P 〉 0.05）. ② The survival rate of endothelial cells： At 6 hours after the operation, the mean survival rate of endothelial cells was higher in the Viscoat group than that in the Amvisc Plus group and Hal Nuote group [（93.78±3.14）%, （80.77±3.91）%, （84.91± 6.71 ）%, P 〈 0.01]. ③ The morphous and structural feature of corneal endothelial cells： Under the light microscope, the lesion was the slightest in the Viscoat group. CONCLUSION： The dispersive substance Viscoat is more effective than the others.