1.8 mm小切口超声乳化劈核与常规切口超声乳化白内障吸出术后早期恢复中角膜内皮细胞的变化

Changes of corneal endothelial cells in early recovery period after 1. 8 mm small-incision phacoemulsification nucleus chopping and conventional incision phacoemulsification for cataract

目的比较1.8 mm小切口超声乳化劈核与常规切口超声乳化白内障吸出术治疗白内障术后早期恢复中角膜内皮细胞的变化特点。方法根据不同术式将53例白内障患者分为观察组与对照组,观察组行1.8 mm小切口超声乳化劈核治疗,对照组则采取常规切口超声乳化白内障吸出术,分别于术前1 d,术后1 d、1周、4周测定并记录两组患者视力、散光程度、角膜内皮细胞指标及并发症发生情况。结果观察组有效超声时间、平均超声能量均显著少于对照组(均为P<0.05);与术前1 d比较,两组术后1周、4周,视力、散光程度、角膜内皮细胞面积(corneal endothelial cell area,ECA)、变异系数(coefficient of variation,CV)均显著上升,角膜内皮细胞密度(corneal endothelial cell density,CD)显著下降,差异均有统计学意义(均为P<0.05);观察组术后1 d、1周、4周,视力、ECD水平均显著高于对照组,散光程度、ECA、CV均显著低于对照组,差异均有统计学意义(均为P<0.05);观察组术中、术后并发症发生率均显著低于对照组(均为P<0.05)。结论超声乳化白内障吸出术后患者角膜内皮细胞多遭受不同程度的损伤,但相比传统切口超声乳化白内障手术,1.8 mm小切口超声乳化劈核治疗术对角膜内皮细胞的损伤明显减轻,且能明显缩短超声时间,减少超声能量,减轻患者术后散光程度,进而显著提高其术后视力,减少术后角膜水肿发生。

Objective To compare the changes of corneal endothelial cells in early recovery period after 1.8 mm small incision phacoemulsification nucleus chopping and conventional incision phacoemulsification for cataract. Methods Fifty-three patients with cataract were divided into the observation group and control group according to different operation methods. The observation group was treated with 1.8 mm small incision phacoemulsification nucleus chopping while the control group was treated with routine incision phacoemulsification. The visual acuity, degree of astigmatism, corneal endothelial cell indexes and complications were observed. Results The effective ultrasound time and average ultrasonic energy of the observation group were significantly less than those of the control group （ all P 〈 0.05 ）. Compared with 1 day before operation,the visual acuity, degree of astigmatism, corneal endothelial cell area （ECA） and coefficient of variation （CV） were significantly increased at 1 week and 4 weeks after operation, and corneal endothelial cell density （ECD） was significantly decreased （ all P 〈 0.05 ）. The visual acuity and ECD levels of the observation group at 1 day, 1 week and 4 weeks after operation were significantly higher than those of the control group, while the degree of astigmatism, ECA and CV were significantly lower than those of the control group （ all P 〈 0.05 ）. Conclusion Compared with the traditional incision phacoemulsification, the damage of 1.8 mm small incision phacoemulsification nucleus chopping to corneal endothelial cells is significantly milder, can reduce the effective ul- trasound time and average ultrasonic energy, decrease the degree of astigmatism, improve the visual acuity and decrease the corneal edema.