分析非超声乳化白内障手术娩核方式对角膜内皮的影响

Analysis of the Effect of Non-phacoemulsification Cataract Operation on Corneal Endothelial Cell Nucleus Division

目的:探讨非超声乳化白内障手术两种不同的娩核方式对角膜内皮细胞数量和形态的影响,以及对术后视力恢复情况的影响。方法:选择在本院手术治疗的40例白内障患者娩核方式分为直接娩出组和半娩出组,并根据Emerylittle晶状体核硬度分级标准分为软核和硬核,手术方式为白内障非超声乳化手术,术后第3天用角膜内皮镜检查并记录角膜内皮细胞数量和形态。术后随访3个月,比较并观察4组患者术前和术后角膜内皮细胞丢失率、形态变化和视力恢复情况。结果:术前和术后3个月角膜内皮细胞丢失率比较,硬核直接娩出组与另外三组比较差异有统计学意义(P<0.01),而软核直接娩出组、硬核半娩出组与软核半娩出组比较差异无统计学意义(P>0.05)。术前和术后第二天视力比较硬核半娩出组和软核直接娩出组之间无统计学意义(P=0.49),软核半娩出组与这两组比较有统计学意义(P=0.03),硬核直接娩出组与这两组之间比较也有统计学意义(P=0.14),术后三个月视力比较4组之间均无统计学意义(P=0.067)。术后3个月角膜内皮细胞形态变化不明显。结论:白内障非超声乳化手术时,硬核直接娩核法对角膜内皮细胞损伤最大,软核半娩核法对角膜内皮损伤最小。若内皮细胞损伤较轻,对手术3个月后视力和角膜内皮细胞形态无明显影响。

Purpose： To investigate the effect of non-phacoemulsification cataract operation in two different patterns of nucleus delivery on the quantity and morphology of corneal endothelial cells and postoperative visual acuity. Methods： Forty patients diagnosed with cataract underwent cataract surgery and were assigned into the direct nuclear delivery and semi-nuclear delivery groups. Lens density was measured and divided into the hard and soft lenses according to Emery-little lens nucleus grading system. Non-phacoemulsification cataract operation was performed. At 3 d after surgery, the quantity and morphology of corneal endothelium were counted and observed under corneal endothelial microscope. During 3-month postoperative fol- low-up, the endothelial cell loss rate, morphological changes and visual acuity were compared among four groups. Results： Corneal endothelial cell loss rate in the direct delivery of hard nucleus group significantly differed from those in the other three groups before and 3 months after operation （P〈0.01）, whereas no statistical significance was found among the direct delivery of soft nucleus, semi-delivery of hard nucleus and semi-delivery soft nucleus groups （all P〉0.05）. Preoperative and postoperative 2-d visual acuity did not differ between the semi-delivery of hard nucleus and direct delivery of soft nucleus groups （P=0.49）,significantly differed from those in the semi-delivery of soft nucleus （P=0.03） and direct delivery of hard nucleus groups（P=0.14）. Visual acuity at postoperative four months did not differ among four groups （P= 0.067）. Conclusion： During non-phacoemulsification cataract surgery, direct delivery of hard nucleus caused severe injury to corneal endothelium and semi-delivery of soft nucleus yielded mild corneal endothelial injury. Slight corneal endothelial injury exerted no apparent effect upon visual acuity and corneal endothelial morphology at three months after surgery.