外伤性无晶体眼二期人工晶状体植入术后角膜内皮形态及角膜厚度的改变

Changes of Corneal Endothelium Morphology and Thickness after Secondary Intraocular Lens Implantation of Traumatic Aphakia

目的:了解外伤性无晶体眼患者二期人工晶状体植入术对角膜内皮形态及角膜厚度的影响。方法:将2004年12月至2005年5月于中山眼科中心外伤科2组行二期人工晶状体植入术的所有患者纳入本研究,测量患者术前、术后角膜5个方位的角膜内皮细胞形态及角膜厚度,比较术前、术后角膜内皮细胞形态及角膜厚度的变化。结果:纳入研究患者21例,11例行经上方角巩缘植入PMMA人工晶状体植入术,10例在平坦部玻璃体腔内灌注下行经上方角巩缘植入PMMA人工晶状体缝襻固定术。手术前后上方角膜内皮细胞的变异系数增加,而六角形细胞的比例下降;其他位置角膜内皮细胞的变异系数及六角形细胞的比例都没有明显改变。没有眼内灌注及缝襻固定的患者术后一周及一个月复查角膜厚度均同术前无明显差别;而行眼内灌注缝襻固定术的患者术后一周发现角膜明显变厚。结论:角膜穿通伤口附近的角膜容易出现术后持续性水肿。手术操作容易损伤手术切口附近的角膜内皮。人工晶状体手术切口应避免角膜穿通口位置。短时间的眼内灌注会暂时影响角膜内皮细胞的功能而导致角膜水肿。手术中器械损伤是角膜内皮损伤的主要原因。

Purpose： To find out changes of corneal endothelium morphology and corneal thickness after secondary intraocular lens implantation of traumatic aphakia. Methods： Twenty-one patients with traumatic aphakia were included in this study. According to the ocular presentation only two surgical methods were performed： secondary PMMA lens implantation through superior corneoscleral incision and transcleral fixation of PMMA intraocular lens with intraocular infusion. Photographs were taken at 5 points area of cornea, including central, superior, inferior, temporal, and nasal points. Endothelial density, area, variation and corneal thickness were measured before and after the operation. thickness after the operation were analysed. also discussed. The changes of corneal endothelium and Factors that induced the changes were . Results： 1.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 hexagonality of corneal endothelium decreased and cell variation increased in the superior cornea after the operation, but they both did not change in other places of cornea. The corneal thickness of patients without intraocular infusion and transcleral fixation did not change after the operation. But the corneal thickness of each corneal point of patients without intraocular infusion and transcleral increased equally after the operation. Conclusions： Corneal swelling occurred in patients undergoing transcleral fixation of PMMA intraocular lens with intraocular infusion. Intraocular infusion will temporally influence the function of corneal endothelium, which induces corneal swelling. Corneal endothelium is damaged mainly by surgical manipulation.