Fuchs角膜内皮营养不良患者白内障手术的临床观察

Clinical observations of Fuchs endothelial dystrophy after cataract surgery

目的 观察Fuchs角膜内皮营养不良（FED）患者行白内障摘除联合IOL植入术的安全性及手术效果.方法 回顾性系列病例研究.对2009年12月至2012年12月在青岛眼科医院确诊为FED合并有白内障的18例患者（30眼）分别行白内障超声乳化摘除联合IOL植入术（27眼）或白内障囊外摘除联合IOL植入术（3眼）.观察手术前后角膜内皮细胞密度（CD）、细胞面积变异系数（CV）、中央角膜厚度（CCT）以及视力、眼压的变化,分析影响角膜内皮细胞变化的因素.数据采用配对t检验、Wilcoxon秩和检验、Pearson相关进行分析.结果 30眼中有5眼术前术后CD测不出,其余25眼手术前后CV差异无统计学意义（t=0.444,P＞0.05）,手术前后CD分别为（2 270.6＆#177;559.0）cells/mm2和（1 750.4＆#177;585.0） cells/mm2,差异有统计学意义（t=4.759,P＜0.01）.角膜内皮细胞丢失率为（21.78＆#177;20.67）％.术后CCT为（543.0＆#177;34.5） μm,术后视力较术前提高（Z=-4.693,P＜0.01）.术后CCT与术后CD（r=-0.428,P＜0.05）、CV （r=0.434,P＜0.05）显著相关.术后角膜内皮细胞丢失率与累积释放能量呈正相关（r=0.466,P＜0.01）.无一例发生角膜内皮功能失代偿.结论 FED患者行白内障摘除联合IOL植入术是安全、有效的,术中应采取相应措施尽量减少内皮细胞的损伤.

Objective To evaluate the effect of Fuchs endothelial dystrophy （FED） on the corneal endothelial cells of patients undergoing cataract surgery.Methods In this retrospective case series study,18 patients （30 eyes） with FED who were treated at Qingdao Eye Hospital from December 2009 to December 2012 were included.Twenty-seven eyes underwent phacoemulsification,and extracapsular cataract extraction was performedon 3 eyes.Corneal endothelial cell density （CD）,the coefficient of variation of the cell area （CV）,central corneal thickness （CCT）,visual acuity and intraocular pressure were evaluated and statistical analyses were performed.Data were analyzed using a paired t test,Wilcoxon ranks test and Pearson correlation.Results The preoperative CD of five eyes could not be determined.The difference between preoperative and postoperative CV in the remaining 25 eyes was not statistically significant （t=0.444,P〉0.05）.The preoperative and postoperative CDs were 2 270.6＆#177;559.0 cells/mm2 and 1 750.4＆#177;585.0 cells/mm2,respectively （t=4.759,P〈0.01）.The loss rate for endothelial cells was 21.78＆#177;20.67%.The postoperative CCT in all FED patients was 543.0＆#177;34.5 μm.Postoperative visual acuity improved significantly compared with preoperative visual acuity （Z=-4.693,P〈0.01）.Postoperative CCT was significantly correlated with postoperative CD （r=-0.428,P〈0.05） and CV （r=0.434,P〈0.05）.The loss rate of corneal endothelial cells was significantly correlated with the cumulative dissipated energy （r=-0.466,P〈0.01）.No bullous keratopathy occurred in any patients during the follow-up period.Conclusion Cataract extraction and intraocular lens implantation is safe and effective for patients with FED.Some measures should be taken into consideration to reduce the loss of endothelial cells.