白内障超声乳化术后早期区域性角膜水肿的临床研究

Early regional corneal edema after cataract phacoemulsification

目的探讨白内障超声乳化术后早期区域性角膜水肿的临床特征。方法收集行白内障超声乳化联合人工晶体植入术的患者50例(50只眼)。采用角膜内皮显微镜(corneal specular microscope,CSM)对手术前后角膜中央、12点、3点、6点及9点位的5个象限,每一象限的5个区域总共25个位置的角膜内皮细胞(corneal endothelial cells,CECs)进行拍照、图像合并及数字化分析。采用眼前节光学相干断层扫描仪(anterior segment optical coherence tomography,AS-OCT)获取白内障手术前后全角膜厚度图,分析区域性角膜水肿与区域性CECs密度(corneal endothelial cell density,CD)改变的相关性。结果入组50例手术均顺利实施,随访期(12.5±1.1)个月。5个象限共25个位置CEC数据显示:术后1 d,平均CD为(2 045±153)个/mm2,较术前平均(2 557±265)个/mm2差异有统计学意义(P<0.01)。与中央区参数相比,12、3、6、9点位CD差异均存在统计学意义(P<0.01)。术后1 d,在中央、12、6、9、3点位,角膜厚度变化分别为(162.7±84.8)、(285.1±114.5)、(121.1±91.2)、(257.2±123.4)、(145.1±91.4)μm,均较术前增加(P均<0.01)。术后1 d,区域性CD减少与区域性角膜水肿存在正相关(r=0.87,P=0.001)。结论白内障术后区域性的角膜厚度增加可间接反映区域性CD减少的程度。

Objective To study the clinical characteristics of early regional corneal edema after cataract phacoe mulsification. Methods Fifty patients（ 50 eyes）, who underwent cataract phacoemulsification and IOL implantation,were enrolled in the study. The corneal specular microscope（ GSM） was used to capture 25 photos of corneal endothelial cells at 5 regions located in cener of cornea,12,3,6,and 9 o＇clock,the photos were then combined and analyzed with photoshop software. Anterior segment optical coherence tomography（ AS-OCT） was used to capture the digital maps of the whole corneal thickness. Relationship of the regional corneal edema and corneal endothelial cells density（ CD） changes were analysed. Results All the surgeries 50 cases were perform successfully,the followup period was（ 12. 5 ± 1. 1） months. The average CDs based on the 25 photos of each cornea were（ 2 557 ± 265） cells / mm^2 before surgery and（ 2 045 ± 153） cells / mm21 day after surgery（ P 〈0. 01）. Compared to the central CD,CDs in the 12,3,6,9 O＇clock showed significant differences（ all P〈 0. 01）. Compared to the corneal thickness before surgery,the thickness changes at d1 after surgery in the center of cornea,12,6,9 and 3 o＇clock were（ 162. 7 ± 84. 8）,（ 285. 1 ± 114. 5）,（ 121. 1 ±91. 2）,（ 257. 2 ±123. 4）,（ 145. 1 ±91. 4） μm respectively（ P 〈0. 01）. The regional CD was correlated with regional corneal thickness changes（ r = 0. 87,P = 0. 001）. Conclusion The increasing of regional corneal thickness can reflect the degree of regional CD decreasing after cataract phacoemulsification.