玻璃体手术方式对角膜内皮细胞的影响

Effects of different vitreoretina surgeries on corneal endothelial cells

目的:探讨不同的玻璃体手术方式对角膜内皮细胞计数的影响,提示硅油取出的最佳时机。方法:根据手术方式及硅油填充情况,对符合本研究条件37例40眼的玻璃体视网膜疾病患者进行分组,分别为单纯玻璃体切割术组(A组)、玻璃体切割联合硅油填充术组(B组)及玻璃体与晶状体切割联合硅油填充术组(C组)。用角膜内皮镜分别测量这三组病例术前1d和术后1wk;1,3,6mo的角膜内皮细胞计数,比较手术前后以及同一时期不同组间角膜内皮细胞计数的变化。结果:三组病例术后1wk及1mo的角膜内皮细胞计数较术前相比无统计学上的差异;单纯玻璃体切割术组术后3,6mo的角膜内皮细胞计数较术前相比亦无统计学上的差异;玻璃体切割联合硅油填充术组术后3mo的角膜内皮细胞计数较术前相比无统计学上的差异,而术后6mo的角膜内皮细胞计数较术前相比明显减少,在统计学上有差异;玻璃体与晶状体切割联合硅油填充术组术后3,6mo的角膜内皮细胞计数较手术前明显减少,统计学上有差异。结论:在眼压控制良好的情况下,有晶状体眼行玻璃体切割硅油填充术后6mo角膜内皮细胞计数明显减少;而无晶状体眼行玻璃体切割硅油填充术后3mo时角膜内皮细胞计数即显著减少。这一结果说明玻璃体腔内硅油填充能够明显减少角膜内皮细胞数,而我们在玻璃体切割硅油填充术组保留了晶状体,这时我们观察玻璃体腔中硅油填充6mo时角膜内皮细胞计数才明显减少,表明晶状体的存留对于角膜内皮的保护具有积极的意义。

AIM：To investigate the impact of different vitreous operations on the corneal endothelial cells counts and indicate the best time of silicon oil withdrawing. METHODS：Depending on different pathological changes, 37 patients 40 eyes with vitreoretinal disease were divided into three groups, respectively they underwent the pure vitrectomy, vitrectomy silicon oil retinal tamponade, and vitrectomy lensectomy silicon oil tamponade. Corneal endothelium microscope was used to respectively measure the corneal endothelial cell counts of these three groups of cases according to the frequency of 1 day before operation, 1 week, 1 month, 3 months, and 6 months after operation. The changes of corneal endothelial cell counts before and after the operation were compared. RESULTS：There were no statistical differences in the corneal endothelial cell counts among these three groups 1 week after operation and 1 month after operation, compared with the preoperative observation. For the group of pure vitrectomy, there were also no statistical differences in the corneal endothelial cell counts 3 months and 6 months after operation, if compared with the preoperative observation. For the group of vitrectomy silicon oil retinal tamponade, there were also no statistical differences in the corneal endothelial cell counts 3 months after operation, compared with the preoperative observation. However, there were significant decreases in the corneal endothelial cell counts 6 months after operation, and there were statistical differences. For the group of vitrectomy lensectomy silicon oil tamponade, there were significant decreases in the corneal endothelial cell counts in the corneal endothelial cell counts 3 and 6 months after operation, compared with the preoperative observation, and there were statistical differences. CONCLUSION：For the vitrectomy with reteniton of crystalline lens silicon oil tamponade, there are significant decreases in the corneal endothelial cell counts 6 months after operation, under the premise that the intraocular prossure is under good control. However, for the aphakia vitrectomy silicon oil tamponade, there are significant decreases in the corneal endothelial cell counts at the time of 3 months after operation. This result indicates that the long-term silicon oil tamponade inside vitreous body can significantly reduce the corneal endothelial cells counts. However, there are significant decreases in the corneal endothelial cell counts only at the time of 6 months after the long-term silicon oil tamponade in vitreoretinal surgical operation and vitreous chamber, which shows that the retention of crystalline lens has positive significance in the protection of corneal endothelium.