白内障超声乳化术后角膜内皮细胞的形态学变化

A study of corneal endothelial cells＆#39; morphology after phacoemulsification

目的 探讨白内障超声乳化术对角膜内皮细胞（CEC）形态学的影响.方法 自身对照研究.50例（50眼）行白内障超声乳化联合人工晶状体植入术,用角膜内皮显微镜（CSM）对手术前及术后12个月角膜中央及5.5 mm处12点、3点、6点、9点5个点位,每一点位的5个区域（中央-C、上方-S、颞侧-T、鼻侧-N、下方-I）,共25个点的CEC进行拍照及图像合并.计算图像数字化后的CSM常用参数及新参数：细胞分型比例、细胞边长变异、角度变异、暗区面积等.采用单因素方差分析中的Dunnett-q检验比较各象限参数与中央区参数,手术前后的参数比较采用配对t检验.结果 术后12个月与术前比较,细胞密度（CD）[术前（2 854-＆#177;290） cells/mm2、术后（2 035＆#177;150）cells/mm2,t=17.86]、平均细胞面积（Save）[术前（351土29）μm2、术后（606＆#177;59）μm2,t=27.14]差异均有统计学意义（P均＜0.01）;六角形细胞比例（HEX）[术前（63.5＆#177;4.2）％、术后（61.2＆#177;3.7）％]、六角形细胞边长变异（Ev）[术前（19.7＆#177;2.5）％、术后（20.2＆#177;2.2）％]、六角形细胞角度变异（Av）（术前158.4＆#176;＆#177;27.5＆#176;、术后155.3＆#176;＆#177;19.1＆#176;）、多边形细胞比例[术前（12.3＆#177;2.7）％、术后（11.2＆#177;3.4）％]、五边形细胞比例[术前（4.8土2.2）％、术后（5.7＆#177;2.4）％]的差异均无统计学意义;CEC暗区数量（术前0.31＆#177;0.14、术后0.83＆#177;0.25,t=18.65）及暗区面积[术前（81.3＆#177;55.2）μm2、术后（244.9＆#177;131.6）μm2,t=5.25]的差异均有统计学意义（P均＜0.01）.术后12个月,以上CEC参数在角膜中央5.5 mm范围内的4个代表性点位（12点位、3点位、6点位、9点位）和中央区相比,差异均有统计学意义（P均＜0.01）.结论 白内障术后的较长时间内CEC未完全再平均分布,采用多象限多点位分析的方法更能反映整个角膜CEC的特点.

Objective To analyze the influence of phacoemulsification on the morphological changes of corneal endothelial cells （CEC）.Methods This was a self-controlled study.Fifty patients （50 eyes） under phacoemulsification and intraocular lens implantation were analyzed.The cornea was divided into five quadrants including central,superior,inferior,nasal and temporal.The corneal specular microscope （CSM） was used to collect CECs＆#39; images and data from five sections （central,superior,inferior,nasal and temporal） in each quadrant （25 sections in total）.The images were collaged,and the data were measured by Image J 1.38X.All the conventional CSM parameters and new parameters including proportion of cell types,variations of cell side length and cell angle were analyzed respectively.The difference between parameters in the central and the other quadrants were compared.Results All the surgeries on 50 eyes were carried out successfully,and there was no complications during and post operation except for slight corneal edema limited to the incision area.Comparing the data before and 12 months after the operations in 25 sections,there were significant difference （both P〈0.01） in the cell density （CD） （changed from 2 854＆#177;290 mm2 to 2 035＆#177;150 mm2,t=17.86） and the average cell area （Save） （changed from 351＆#177;29 μm2 to 606＆#177;59 μm2,t=27.14）.There was no significant difference in HEX% （pre-operation was 63.5＆#177;4.2 and 12 months post-operation was 61.2-＆#177;3.7）,the variation of side length of CECs （pre-op was 19.7＆#177;2.5 and post-op was 20.2＆#177;2.2）,the variation of angle of CECs （pre-op was 158.4＆#176;＆#177;27.5＆#176; and post-op was 155.3＆#176;＆#177;19.1＆#176;）,the portion of polygon cells （pre-op was 12.3%＆#177;2.7%,post-op was 11.2%＆#177;3.4%）,and the portion of pentagon cells （pre-op was 4.8%＆#177;2.2% and post-op was 5.7%＆#177;2.4%）.There were significant difference in the number of CEC dark zone （pre-op was 0.31＆#177;0.14 and post-op was 0.83＆#177;0.25）,and the area of CEC dark zone （pre-op was 81.3＆#177;55.2 and post-op was 244.9＆#177;131.6） （t=18.65 and t=5.25,both P〈0.01）.Twelve months after surgery,compared all the parameters above in central quadrant to those in other quadrants,there were significant difference （all P〈0.01）.Conclusion CEC were not equally-distributed 12 mon after phacoemulsification,collecting the CEC data from multiple quadrants and multiple sections after phacoemulsification is a better way to show the characteristics of CEC.