手法小切口白内障摘除术后早期角膜生物力学特性的变化

Early changes in the biomechanical properties of the cornea after manual small incision cataract surgery

目的:观察年龄相关性白内障患者手法小切口白内障摘除术(manual small incision cataract surgery,MSICS)后1d角膜滞后性(corneal hysteretic,CH)、角膜阻力因数(cornealresistance factor,CRF)、角膜补偿眼压(corneal compensa-ted IOP,IOPcc)、Goldmann相关眼压(goldmann correlatedIOP,IOPg)的变化规律,并探讨MSICS术后早期角膜生物力学特性改变的相关因素。方法:应用Reichert眼反应分析仪(ocular response analy-zer,ORA)测量50例50眼年龄相关性白内障患者术眼MSICS术前及术后1d的CH,CRF,IOPg,IOPcc。用SPSS10.0统计学软件分析各测量值的变化规律以及CH变化量与眼压变化量的相关性。结果:术后1d的CH,CRF较术前下降(P<0.01;P<0.01),IOPcc,IOPg较术前升高(P<0.01;P=0.001),CH降低量与眼压增加量呈正相关性(IOPg,r=0.492,P<0.01;IOPcc,r=0.688,P<0.01)。结论:年龄相关性白内障患者手法小切口白内障摘除术后早期角膜生物力学特性明显改变,术后角膜不同程度的水肿和眼压的升高可能是导致改变的主要原因。

AIM：To assess the early changes of corneal hysteretic （CH）, corneal resistance factor （CRF）, corneal compensated IOP（IOPcc）, goldmann correlated IOP（IOPg） in the biomechanical properties of the cornea using the ocular response analyzer （ORA） 1 day after manual small incision cataract surgery （MSICS） and to explore the relevant factors of the changes. METHODS： Fifty eyes of 50 patients who underwent MSICS and IOL implantation were evaluated. CH, CRF, and IOPg, IOPcc were measured by ORA before surgery and on the first day after operation. The changes of observed value and the correlation between CH changes and lOP changes were analyzed by SPSS 10.0.RESULTS. CH（8.41±1.12mmHg vs 9.75±0.89mmHg P〈0.01）and CRF（6.97±1.14mmHg vs 7.62±1.36mmHg, P 〈 0.01） decreased compared with that of the preoperative, but IOPcc （16.65±5.15mmHg vs 12.74±3.83 mmHg, P〈0.01）, IOPg（13.88±3.50mmHg vs 12.03±3.69mmHg, P=0.001） increased. The correlation coefficient between the decrement of CH and the increment of IOPg was 0.492 （P〈0.01）, between the decrement of CH and the increment of IOPcc was 0.688 （P〈0.01）. CONCLUSION： MSICS with IOL implantation using modern technology may change the biomechanical properties of the cornea in the early postoperative period. Postoperative corneal edema leads to the change of corneal viscoelastic properties, resulting in a lower damping capacity of the cornea. Simultaneously raised lOP is also a major reason for the changes.