超声乳化术对低密度角膜内皮细胞眼的影响

Influence of phacoemulsification on eyes with low corneal endothelial cell density

目的观察晶状体超声乳化人工晶状体植入术对角膜内皮细胞密度低眼的损害程度。方法前瞻性病例对照研究。将晶状体超声乳化人工晶状体植入术的患者按年龄及核硬度匹配后分为两组。试验组，角膜内皮细胞密度600～1000个／mm2；对照组，角膜内皮细胞密度〉2300个／mm2。每组35例（35只眼）。术前及术后3个月、6个月测量角膜内皮细胞密度和中央角膜厚度，对角膜内皮细胞丢失率和中央角膜厚度增加率进行比较。结果术后3个月平均角膜内皮细胞丢失率两组差异无统计学意义（x2=1．97，P=0．16），术后6个月两组差异也无统计学意义（X2=0．50，P=0．48）。术后3个月试验组中央角膜厚度增加率高于对照组（X2=10．83，P=0．00），但术后6个月两组差异无统计学意义（X2=1．27，p=0．26）。结论角膜内皮细胞密度低的患者超声乳化人工晶状体植入术后，角膜内皮细胞的损害程度与角膜内皮细胞密度正常的患者相当，并且中央角膜厚度呈一过性增加，大部分患者术后6个月恢复。

Objective To observe the damage of phacoemulsification and intraocular lens （IOL） implantation in eyes with low corneal endothelial cell density （ECD）. Methods This is a prospective case- control study. Patients who accepted phacoemulsification and IOL implantation were divided into two groups according to age and nuclear hardness. The patients with corneal ECD between （600-1000）/mm2 were divided into the clinical trial group and those over 2300/mm2 into the control group. There were 35 eyes of 35 cases in each group. The ECD and central corneal thickness （CCT）were measured preoperatively and 3, 6 months postoperatively, and the percentage of cell loss and increase in CCT were compared between two groups. Results There was no significant difference in the percentage of corneal endothelial cell loss between two groups at 3 months postoperatively （X2 = 1. 97, P = 0. 16）, and there was no significant difference at 6 months postoperatively （X2 = 0. 50, P = 0. 48 ）. The percentage of increase in CCT was significantly greater in the clinical trial group than in the control group at 3 months postoperatively （X2 = 10. 83, P =0.00）, although there was no significant difference at 6 months postoperatively（X2 = 1.27 ,P = 0. 26）. Conclusion Corneal endothelial cell damage after phacoemulsification and IOL implantation in eyes with low ECD is slight and comparable to that in healthy eyes. The increase of CCT may be temporary after phacoemulsiflcation, but then most recovers considerably by 6 months postoperatively.