白内障摘除术后角膜上皮功能障碍临床病例分析

Clinical study on the corneal epithelial dysfunction after cataract extraction

目的 分析白内障摘除术后角膜上皮功能障碍的临床特点及其疗效.方法 回顾性病例研究.收集2014年11月至2016年9月在首都医科大学附属北京同仁医院眼科门诊临床诊断为白内障摘除术后角膜上皮功能障碍患者15例,其中男性6例,女性9例.年龄59～86岁,平均（65.2±4.2）岁.单眼发病9例.对所有患者一般情况、眼部症状和体征特点、角膜激光共聚焦显微镜扫描图像特点、治疗疗效进行分析.结果 15例患者中3例患者伴有睑缘炎.角膜病变特点包括角膜上皮弥漫性的点状或点簇状混浊、假树枝状混浊或角膜上皮片状缺损、丝状剥脱,基质水肿.角膜激光共聚焦显微镜检查发现,角膜上皮基底细胞核反光均增强,细胞形态不规则且细胞密度明显下降,基底细胞计数平均值为（4 839±285）个/mm2;角膜上皮下神经纤维直径变细,且有中断现象.经过保护眼表及促进角膜上皮修复的治疗后,15例患者角膜上皮病变全部临床治愈.结论 白内障摘除术后角膜上皮功能障碍的早期表现为角膜上皮水肿、点状染色,如未能及时诊断与治疗,可发展为丝状角膜炎或角膜溃疡;及时给予保护及促进角膜上皮修复的药物治疗,效果良好.

Objective To study the clinical manifestations,diagnosis and treatment of corneal epithelial dysfunction after cataract extraction.Methods Fifteen cases diagnosed as corneal epithelial dysfunction after cataract extraction between November 2014 and September 2016 were retrospectively analyzed,mainly including clinical manifestations,characteristics of morphological changes imaged by in vivo laser confocal microscopy,management and therapeutic effects.Results There were 6 （40%） males and 9 （60%） females with an average age of 66±7 years （59 to 86 years）.Three patients had meibomian gland dysfunction.The clinical manifestations of corneal epithelial dysfunction after cataract extraction were corneal epithelial permeability increase,limitations of epithelial edema,corneal epithelial dot staining,corneal epithelial defects and ulceration.In vivo laser confocal microscopy showed enhanced reflection of the nucleus of the corneal basal cells,abnormal cell structure and decreased cell density.The morphology of corneal sub-basal nerve plexus was disordered and diminutive.After the therapy of protecting corneal epithelium and promoting healing,all 15 cases were cured completely.Conclusions The early characteristics of cataract extraction-related corneal epithelial dysfunction are edema of the corneal epithelium and dot staining.Delayed diagnosis and treatment may result in filamentous keratitis and corneal ulcers.Timely use of corneal epithelium protection medicine may contribute to a favorable prognosis.