应用共焦显微镜观察白内障超声乳化术后角膜内皮变化情况

Clinical observation on the changes of corneal endothelium after phacoemulsification by confocal microscopy

目的应用共焦显微镜观察白内障超声乳化术后角膜内皮细胞密度(CD)及六角形细胞百分比(6A%)的变化。方法随机选取2017年1月至2017年6月期间,在我院行白内障超声乳化吸出联合人工晶体植入术的年龄相关性白内障患者48例50眼。分别于术前1天、术后1周、术后1个月及术后3个月应用共焦显微镜对患者进行角膜内皮检查,记录所有患者的角膜内皮细胞密度(CD)及六角形细胞百分比(6A%),最后进行统计学分析。结果内皮细胞密度(CD)在术后各时间点与术前相比差异均有统计学意义(P<0.05),这种差异随着患者恢复时间的延长,有逐渐缩减的趋势。六角形细胞百分比(6A%)在术后呈下降趋势,1周时最显著,差异有统计学意义(P<0.05),之后逐渐恢复,到3个月时已基本恢复到术前水平。术后细胞早期呈多型性,细胞水肿,体积增大,术后3个月已基本恢复。结论共焦显微镜可以用来观察活体角膜内皮细胞的密度、形态结构及其动态变化;白内障超声乳化术后角膜内皮细胞密度及六角形细胞比例均有不同程度下降,至术后3个月均有所修复;角膜内皮细胞无法再生。

Objetive To observe the changes of corneal endothelial cell density （CD） and percentage of hexagonal cells （6A%） after phacoemulsification by confocal microscopy. Methods From January 2017 to June 2017,fifty-six cases of age-related cataract patients with cataract underwent phacoemulsification combined with intraocular lens implantation in our hospital. Corneal endothelium was examined by confocal microscopy at 1 day, 1 week, 1 month and 3 month after surgery. All patients were examined for corneal endothelium cell density （CD） and hexagonal cell percentage （6A%） and analyzed. Results The difference of endothelial cell density （CD） between the two groups was statistically significant （P 〈0.05） at each time point after operation, and the difference was gradually decreased with the recovery time of the patients. The percentage of hexagonal cells （6A%） decreased after surgery, the difference was statistically significant （P 〈0.05） at 1 week, and then gradually recovered. And after 3 months it has been basically restored to preoperative level. Conclusion Confocal microscopy can be used to observe the density, morphological structure and dynamic changes of living comeal endothelial cells. Corneal endothelial cell density and the proportion of hexagonal cells were reduced to varying degrees after cataract phacoemulsiftcation, but repaired after three months. Corneal endothelial cells can not be regenerated.