飞秒激光辅助白内障手术后角膜内皮细胞变化及其影响因素的临床分析

Clinical analysis of changes in corneal endothelium and its influencing factors after femtosecond laser assisted cataract surgery

目的探讨飞秒激光辅助白内障手术对角膜内皮细胞计数变化(个/mm2)及其影响因素。方法前瞻性病例对照研究。将2015年1月至2016年12月在我院行飞秒激光辅助白内障手术+人工晶状体植入术的白内障患者121例(121只眼)纳入研究对象。收集的临床资料包括患者年龄、性别、眼轴长度、前房深度、晶状体核分级、术中超声能量(CDE)、术前和术后1周、1个月、3个月角膜内皮细胞计数。分组方法:根据术前眼轴长度分成两组:A组:24 mm≤眼轴≤27 mm,54只眼;B组:21 mm≤眼轴<24 mm,67只眼。根据术前晶状体核分级分成两组:C组65只眼,Ⅱ级核;D组56只眼,Ⅲ级核。根据术前前房深度分成两组:E组:3 mm≤前房深度≤3.4 mm,60只眼;F组:2.6 mm≤前房深度<3 mm,61只眼。比较术前与术后1周、1个月、3个月角膜内皮细胞计数的差异。比较不同眼轴、晶状体核分级、前房深度的患者术中CDE和术前及术后1周、1个月、3个月角膜内皮细胞计数的差异,采用SPSS24.0统计学软件进行数据分析。结果本研究中,术中CDE为:6.86±0.93。术后1周、1个月、3个月分别与术前相比,角膜内皮细胞计数的差异均有统计学意义(P<0.05)。不同眼轴:A组与B组术中CDE分别:6.90±1.01、6.83±0.87。不同晶状体核分级:C组与D组术中CDE分别:6.88±0.98、6.84±0.87。不同前房深度:E组与F组术中CDE分别为:6.90±1.00、6.83±0.87。不同眼轴、不同晶状体核分级、不同前房深度分组的患者术中CDE相比,差异无统计学意义(P>0.05)。不同眼轴、不同晶状体核分级、不同前房深度分组的患者角膜内皮细胞计数在术前相比,差异均无统计学意义(P>0.05),但在术后1周、1个月、3个月时相比,差异均有统计学意义(P<0.05)。结论飞秒激光辅助白内障手术后不同时期角膜内皮细胞计数较术前均降低,角膜内皮细胞变化与术前眼轴、晶状体核分级和前房深度有关,术前眼轴越长,晶状体核分级越低,前房越深,飞秒激光辅助白内障手术对角膜内皮细胞计数的影响越小。

Objective To investigate the changes in corneal endothelial cell count（ one/mm2） by femtosecond laser assisted cataract surgery and its influencing factors. Methods This study was a prospective case-control study. The 121 eyes of cataract patients underwent femtosecond laser assisted cataract surgery combined with intraocular lens implantation from January 2015 to December 2016 were studied. The clinical data were collected including age,sex,axial length,anterior chamber depth,lens nucleus grading,Intraoperative ultrasound energy（ cumulative dissipated energy,CDE） and corneal endothelial cell counts between preoperatively and 1 week,1 month,3 months postoperatively. Grouping methods： according to the preoperative axial length,the patients was divided into two groups： group A,54 eyes,axial length was more than or equal to 24 mm and less than or equal to 27 mm. B group of 67 eyes,axial length was more than or equal to 21 mm and less than 24 mm. According to the preoperative lens nucleus grading the patients was divided into two groups： 65 eyes in group C,II grade nucleus,56 eyes in group D,III grade nucleus. According to the preoperative anterior chamber depth,the patients was divided into two groups： group E,60 eyes,anterior chamber depth was more than or equal to 3 mm and less than 3. 4 mm; 61 eyes in group F,anterior chamber depth was more than or equal to 2. 6 mm and less than 3 mm. The corneal endothelial cell counts were compared preoperatively and 1 week,1 month,and 3 months postoperatively. The difference of intraoperative CDE and corneal endothelial cell counts between preoperatively and 1 week,1 month, 3 months postoperatively were compared with different axial length,lens nucleus grading and anterior chamber depth. Data were analyzed by SPSS24. 0 statistical software. Results In this study,intraoperative CDE was 6. 86 ± 0. 93. The difference in corneal endothelial cell counts were statistically significant（ P〈0. 05） compared with preoperatively and 1 week,1 month,3 months postoperatively. Different axial length： the CDE in group A and group B was respectively： 6. 89 ± 1. 01,6. 83 ± 0. 87. Different lens nucleus grading： the CDE in group C and group D was respectively： 6. 88 ± 0. 98,6. 84 ± 0. 87. Different anterior chamber depth： the CDE in group E and group F was respectively： 6. 90 ± 1. 00,6. 83 ± 0. 87. There was no significant difference in CDE in patients with different ocular axis,different lens nucleus grading and different anterior chamber depth（ P〉0. 05）. There were no significant differences in corneal endothelial cell counts in patients with different axial length,different lens nuclear grading and different anterior chamber depth preoperatively（ P〉0. 05）,but the difference was statistically significant at 1 weeks,1 months,and 3 months postoperatively（ P〈0. 05）. Conclusions In different periods after femtosecond laser assisted cataract surgery,corneal endothelial cell counts were lower than that preoperatively. The changes of corneal endothelial cells was related preoperative axial length,lens nucleus grading and anterior chamber depth.The longer of the axial length,the lower of the lens nuclear grading and the deeper of the anterior chamber preoperatively,the influence will be smaller of the femtosecond laser assisted cataract surgery on the corneal endothelial cell count.