糖尿病性白内障术后角膜内皮细胞的变化

Study on the morphology of corneal endothelial cells after phacoemulsification in diabetic cataract

目的:观察糖尿病性白内障患者超声乳化术后角膜内皮细胞形态学的变化,探索糖尿病患者术后角膜内皮细胞的变化规律及影响因素。方法:随机选取28例(32眼)非胰岛素依赖型糖尿病合并老年性白内障患者行经透明角膜切口的白内障超声乳化吸除术联合折叠式人工晶体植入术。所有患者于术前、术后3月分别行角膜中央区和手术切口区内皮细胞观察,检测其细胞密度、六角形细胞比例和变异系数。结果:白内障超声乳化术后角膜内皮细胞密度和六角形细胞比例均呈现逐渐下降趋势,变异系数渐增加。术后切口区内皮细胞密度低于中央区,有显著性差异。六角形细胞比例低于中央区,变异系数高于中央区。结论:白内障超声乳化术中,糖尿病患者角膜内皮受到超声因素和机械因素的双重损伤。手术切口区内皮细胞丢失明显大于中央区,所以对于白内障患者尤其合并糖尿病者,在超声因素(能量、时间)损伤的基础上,应注意机械因素的作用;并且这种创伤对角膜内皮的影响可能更大。

Objective： To observe the corneal endothelial cells morphology in the cornea of diabetes patient after phacoemulsification, and find out the regularity of corneal endothelial cells morphologic change and some related influencing factors, Methods： 28 cases （32 eyes） age-related cataract patients with non-insulin dependent diabetes mellituswere randomly choosed in this research. The phacoemulsification was performed through the clear corneal combined with the foldable intraocular lens implantation. The CD, Hexa%, CV of the endothelial cells in the central and incision cornea were examined preoperatively and 3m postoperatively. Results： the level of postoperative CD, Hexa % decreased gradully, and the level of CV increased. Morphology of endothelial cells in the incision corneal showed a significant lower CD and Hexa %, higher CV than those in the central cornea at 3m postoperatively. Conclusion,, In phacoemulsification through the clear corneal, the endothelial cells suffer from energy and mechanic injury, The corneal endothelial cells in incision are easier to be damaged than that in the central part during this surgery ,We should pay more attention to the mechanic injury in diabetes patient, because it lead to more corneal endothelial cell loss.