囊外摘出与超声乳化术对角膜内皮影响的比较

The effect of ECCE and phacoemulsification on corneal endothelium.

目的 比较白内障囊外摘出术 (ECCE)与超声乳化术 (Phaco)对角膜内皮的损伤。方法 118例 ( 12 1眼 )老年性白内障分两组囊外摘出和超声乳化人工晶状体植入术。测量术前、术后 2天及 3月的中央角膜内皮细胞密度、细胞面积变异系数、六边形细胞百分率、中央角膜厚度等指标。结果 术后 3月平均细胞丢失率ECCE组为 ( 12 6± 9 6) % ,Phaco组为 ( 15 4±9 7) % ,两组间差异无显著性 (P >0 0 5 )。术后内皮细胞面积变异系数和六边形细胞百分率与术前比较有显著性差异 (P <0 0 5 )。术后早期角膜厚度增加与内皮细胞损失率无相关性。结论 白内障超声乳化术对内皮细胞的损伤不大于囊外摘出术 ;结合角膜内皮细胞密度和形态学指标能更准确的反映出内皮的损伤 ;术后早期的角膜厚度增加程度不能作为评价内皮损伤的指标。

Objective To evaluate intraoperative endothelial damage after extracapsular cataract extraction (ECCE) and phacoemulsification.Methods In this prospective study, 118 patients with senile cataract were divided into two groups:Group 1 38 eyes had ECCE;Group 2 83 eyes had posterior-chamber phacoemulsification. Endothelial cell density?percentage of hexagonality?cell size variation coefficient and central corneal thickness were examined preoperatively, 2 days and 3 months postoperatively.Results were analyzed with the two loss Student's t-test and analysis of correlation.Results Mean cell loss was(12.6±9 6)% in group 1 and (15 4±9 7)% in group 2 three months postoperatively. There were no significant differences among the postoperative values, although the percentage of cell loss in group 2 was slightly higher than that in group 1.There were differences between the preoperative and postoperative morphometric indexes. There was no correlation between the cell rate and the change of corneal thickness.Conclusion Endothelial cell loss was not statistically significantly different between ECCE and Phaco under modern cataract surgery, It is more acurate to evaluate the corneal injury by combining corneal endothelial density and morphological index.The change of cornea thickness is not a valuable index to estimate the endothelia cell loss.