角膜内皮营养不良患者飞秒激光辅助白内障手术观察

Observation on the femtosecond laser-assisted cataract surgery for patients with Fuchs endothelial corneal dystrophy

目的观察Fuchs角膜内皮营养不良（FECD）伴白内障患者飞秒激光辅助超声乳化手术术后角膜内皮细胞丢失率。方法临床病例前瞻性对照研究。FECD伴白内障18例（31眼），随机分为两组：A组，飞秒激光组，10例（15眼）；B组，传统超声乳化组，8例（16眼）；比较两组术后3d、1个月、3个月角膜内皮细胞丢失率、视力、眼压及并发症。结果两组患者年龄、术前角膜内皮细胞密度、术前、术后视力及眼压差异均无统计学意义（P〉0．05）。术后3d角膜内皮细胞丢失率：飞秒激光组和传统超乳组分别为（12．9±9．3）％、（16．8±4．4）％，差异无统计学意义（t9〉0．05）。术后1个月两组角膜内皮细胞密度丢失率分别为（21．3±9．7）％、（27．2±4．2）％；术后3个月，分别为（23．6±7．2）％、（30．9±5．4）％，差异具有统计学意义（19〈0．05）。随访期间均未出现角膜内皮功能失代偿或大泡性角膜病变。结论飞秒激光辅助超声乳化手术治疗Fuchs角膜内皮营养不良伴白内障安全性高，术后角膜内皮细胞丢失率低，有效减少术后角膜内皮功能失代偿。

Objective To observe the corneal endothelial cell loss after femtosecond laser-assisted phacoemulsification for the treatment of cataract of Fuchs endothelial corneal dystrophy （FECD） patients. Methods A prospective clinical controlled study. The data of 31 eyes of 18 cases with FECD and cataract were collected and analyzed. They were divided randomly into 2 groups： group A, 15 eyes of 10 cases, received femtosecond laser-assisted phacoemulsification and group B, 16 eyes of 8 cases, underwent conventional phacoenmlsification. The corneal endothelial cell loss, visual acuity, intraocular pressure （lOP） and complications at 3 days, 1 and 3 months after surgery were compared between two groups. Results The difference in age, preoperative corneal endothelial cell density, preoperative and postoperative visual acuity and IOP were not statistically significant between the two groups （ P 〉 0.05 ）. The corneal endothelial cell loss 3 days after surgery in group A was （12.9±9.3 ）% and （16.8 -＋4.4）% in group B. The difference was not statistically significant （P 〉 0. 05 ）. One month postoperatively, the corneal endothelial cell loss in group A was （21.3±9.7）% and （27.2±4.2）% in group B. The difference was statistically significant （ P 〈 0.05 ）. Three months postoperatively, the corneal endothelial cell loss in group A was （23.6± 7.2 ） % and （ 30.9±5.4 ） % in group B. The difference was statistically significant （ P 〈 0.05）. No bullous keratopathy or endothelial dysfunction occurred during follow-up time. Conclusion The femtosecond laser-assisted phacoemulsification is effective and safe for FECD and cataract, it can reduce postoperative corneal endothelial cell loss.