超声乳化术角膜内皮细胞损伤的多因素分析

Analysis of multi -factor of corne al endothelial cell injury in phacoemulsification surgery

目的 探讨造成超声乳化联合人工晶状体植入术后角膜内皮细胞损伤的相关因素。方法 观察 142例手术眼 ,分别记录 :核硬度、超声总能量、术前角膜内皮细胞密度、粘弹剂类型、撕囊方法、人工晶状体类型、麻醉方式。术后观察角膜内皮细胞变化 ,计算术后 1周内和 3个月后细胞损失率。应用 SPSS统计软件进行多因素相关回归分析。结果 角膜内皮细胞损失率在术后 1周内与核硬度、粘弹剂类型密切相关 ;在术后 3个月与核硬度和术前角膜内皮细胞密度密切相关。结论 为了减少超乳术对角膜内皮细胞的影响 ,有必要行角膜内皮细胞检查 ;提高手术技巧、稳定前房、减少能量和机械损失 ;选用良好的粘弹剂 ;有手术适应证的患者应尽早手术。

Objective To investigate the relationship between the corneal endothelial cell injury and phacoemulsification with IOL implantation surgery. Method One hundred and forty two cases were observed.The nuclear hardness, phaco energy, corneal endothelial cell count preporationally, viscoelastic solution type, method of capsulotomy, foldable IOL used or not, method of anaesthesia were recorded.The ratio of endothelia cell loss within 1 week and 3 months after operation was calculated.The SPSS statistics software was used to do stepwise regression analysis.Result The ratio of endothelial cell loss was closely related to the nulcear hardness and the viscoelastic solution type within 1weeks postoperatively,and to the nuclear hardness and the preoperational corneal endothelia cell count 3 months after operation.Conclusion In order to reduce the influence of phacoemulsification surgery on the corneal endothelial cell, it is necessary to examine the endothelial cell before operation, to improve the surgery technique and anterior chamber stability, to reduce the energy and mechanic injury, to use high quality viscoelastic solution and to perform the operation as early as possible for the suitable patients.