低密度角膜内皮细胞白内障超声乳化术的临床观察

Clinical outcomes of phacoemulsification for cataract patients with low corneal endothelial cell density

目的评价超声乳化吸除术在治疗低密度角膜内皮细胞白内障患者的可行性和手术效果。方法对10例（12只眼）角膜内皮细胞密度〈1500个/mm^2的白内障患者行白内障超声乳化吸除人工晶状体植入术。其中Fuchs角膜营养不良3只眼,抗青光眼术后4只眼,颗粒状角膜营养不良2只眼,穿透性角膜移植术后3只眼。使用角膜内皮显微镜检查所有患者术前术后角膜内皮细胞密度,并观察术后视力及角膜水肿变化。结果所有患者术后视力均有不同程度提高,术后3个月最佳矫正视力0.1-0.4者8只眼,≥0.5者4只眼。术后角膜水肿为轻中度,常于术后5-7 d恢复,无角膜内皮细胞失代偿。内皮细胞损失率8.83%。结论低密度角膜内皮细胞白内障患者在一定程度上可行白内障超声乳化联合人工晶状体植入术。严格掌握手术适应证、术中注意保护角膜内皮细胞和由经验丰富的术者完成手术是疗效满意的重要保证。

Objective To evaluate the feasibility and clinical outcomes of phacoemulsification in cataract patients with low endothelial cell density. Methods A total of 10 cataract patients（12 eyes） with low corneal endothelial cell density（ 1500 /mm2） underwent phacoemulsification and intraocular lens（IOL） implantation. Pre-existing conditions of these operated eyes included Fuchs corneal dystrophy（ n = 3）,granular corneal dystrophy（ n = 2）,post-anti-glaucoma surgery（ n = 4）,and post-penetrating keratoplasty（ n = 3）. We used corneal endothelium counter（Tomey EM-3000） to measure corneal endothelial cell counts before and after cataract surgery. Visual acuity and corneal edema were also investigated. Results Visual acuity improved in all patients at 3 months after the cataract surgeries. Best corrected visual acuity was 0. 1 - 0. 4 in 8 eyes and higher than 0. 5 in 4 eyes. Corneal edema was mild to moderate. There was no bulloulskeratopathyreported during follow-up period. The rate of endothelial cell loss was 8. 83%. Conclusion Cataract in eyes with low endothelial cell density may be treated withphacoemulsification and IOL implantation in selected patients. The keys to achieve satisfactory clinical outcomes include careful screening for indications,protect of endothelium during the operation,and being operated by experienced ophthalmologists.