青光眼白内障联合手术与单纯白内障手术对角膜内皮的影响

Influence of glaucoma combined cataract surgery and pure cataract surgery on corneal endothelium

目的:比较青光眼白内障联合手术与单纯白内障手术后对角膜内皮的影响。方法:选择我院40例(40眼)角膜内皮细胞数在(2 700±350)个/mm2,细胞变异系数(65±7.15)%,六角形细胞比例(46±5.04)%的范围内的患者。其中20例(20眼)适合行青光眼白内障联合手术(即小梁切除术+白内障囊外摘除术+后房型人工晶体植入术)为联合组;另20例(20眼)适合行单纯白内障手术(即白内障囊外摘除术+后房型人工晶体植入术)为单纯组。分别对两组患者手术后的角膜内皮细胞密度、细胞大小变异系数(CV)及六角形细胞比例进行检查。结果:联合组术后角膜细胞密度(2204.48±357.64)个/mm2,变异系数(56.32±7.04)%,六角形细胞比例(34.98±5.24)%,单纯组术后角膜内皮细胞数(2548.74±332.98)个/mm2,变异系数(46.08±6.78)%,六角形细胞比例(42.54±4.76)%。联合组与单纯组术后比较角膜内皮细胞密度、细胞大小变异系数(CV)、六角形细胞比例差异有显著性(P<0.05)。结论:青光眼白内障联合手术与单纯白内障手术均对角膜内皮细胞有影响,但联合手术影响更加明显,提示术者在手术过程中提高手术技能,缩短手术时间,最大限度保护角膜内皮的正常功能,以提高手术成功率及术后视力的恢复。

Objective：To compare the influence of cataract surgery combined with glaucoma surgery and pure cataract surgery on corneal endothelium.Methods：To select 40 patients（40 eyes） in our hospital whose corneal endothelium cell population between（2700±350）cells/mm,cell coefficient of variability between（65±7.15）%,and hexagonal cell ratio between（46%±5.04）%.20 of them fitted to do cataract surgery combined with glaucoma surgery（trabeculectomy and extracapsular cataract extraction and posterior chamber intraocular lens implantation）,as the association group;the other 20 cases（20 eyes） fitted to do pure cataract surgery（extracapsular cataract extraction and posterior chamber intraocular lens implantation）,as the pure group.After surgery,the corneal endothelium cell population,cell coefficient of variability and hexagonal cell ratio were determined again.Results：After surgery,corneal endothelium cell population was 2204.48±357.64（cells/mm）,cell coefficient of variability was（56.32±7.04）%,and hexagonal cell ratio is（34.98±5.24）% in association group;but in purely group,corneal endothelium cell population is 2548.74±332.98（cells/mm）,cell coefficient of variability was（46.08±6.78）%,and hexagonal cell ratio was（42.54±4.76）%.Comparing the two groups,all indexes had significant difference.Conclusion： Cataract surgery combined with glaucoma surgery and pure cataract surgery all have influence on corneal endothelium,but the former is more obviously.So the operator should enhance operational skill and shorten operation time as more as possible to protect the normal function of corneal endothelium cell maximally for raising achievement ratio and promoting visual recovery.