角膜内皮检查在高度近视并发白内障术前检查中的应用

Application of corneal endothelial examination in preoperative examination of patients with high myopia complicated with cataract

目的探讨角膜内皮检查在高度近视合并白内障病人手术中的应用价值。方法采用前瞻性病例对照研究。采用随机数字表法选取2019年1-11月在安徽医科大学附属巢湖医院接受超声乳化白内障摘除联合人工晶状体植入术的病人63例(77例次),眼轴>26.0 mm为高度近视组,23.0-25.0 mm作为对照组,其中高度近视组31例(39例次),对照组例32例(38例次)。应用角膜内皮镜分别于术前及术后1周、1月及3月对病人中央角膜厚度(CCT)和内皮细胞密度(CD)以及六角形细胞百分比(6A%)进行观察,汇总后对数据进行统计学分析。结果高度近视组与对照组间术前中央角膜厚度、内皮细胞密度以及六角形细胞百分比间差异无统计学意义(P>0.05);与术前相比较,高度近视组与对照组的内皮细胞密度及六角形细胞百分比均呈下降趋势;术后1周时,高度近视组与对照组的内皮细胞密度分别为(1 965.32±306.39)个/mm^2和(2 135.60±285.31)个/mm^2,与术前相较均差异有统计学意义(P<0.05);术后1周和1月高度近视组中央角膜厚度分别为(642.54±31.10)百和(572.53±25.84)百μm,均高于对照组(P<0.05),3个月时基本恢复至术前水平。结论高度近视合并白内障病人白内障超声乳化术后角膜的损伤更严重,且恢复所需的时间更长;术前角膜内皮检查应作为常规检查项目,以制定个性化治疗方案。

Objective To investigate the value of corneal endothelium examination in the operation of high myopia complicated with cataract.MethodsA prospective case-control study was conducted.A total of 63 patients who underwentd phacoemulsification cataract extraction combined with IOL implantation in Chaohu Hospital Affiliated to Anhui Medical University from January 2019 to December 2019 were randomly selected and designated as highly myopic group according to axial≥26.0 mm,or as the controlgroup according to axial length>23.0 mm and<25.0 mm.Among them,31(39 eyes)patients were in the highly myopic group and32(38 eyes)patients were in the control group.The central corneal thickness(CCT),endothelial cell density(CD)and the per-centage of hexagon cells(6 A%)were observed by corneal endothelium microscopy before surgery,1 week,1 month,and 3 monthsafter surgery,respectively.The data were summarized and statistically analyzed by SPSS 22.0.ResultsThere were no significant differences in the central corneal thickness,endothelial cell density,and percentage of hexagonal cells between the high myopiagroup and the control group before surgery(P>0.05).Compared with those before surgery,the density of endothelial cells and thepercentage of hexagon cells in the high myopia group and the control group showed a decreasing trend.At 1 week after surgery,thedensity of endothelial cells in the high myopia group and the control group was(1965.32±306.39)/mm^2 and(2135.60±285.31)_/mm^2,respectively,which was significantly different from that before surgery(P<0.05).At 1 week and 1 month after surgery,thecentral corneal thickness of the high myopia group was(642.54±31.10)and(572.53±25.84)μm,respectively,which were bothhigher than those of the control group(P<0.05),and basically recovered to the preoperative level at 3 months.Conclusions Inpatients with high myopia and cataract,corneal injury after phacoemulsification is more serious and recovery time is longer.Preoper-ative corneal endothelium examination should be a routine examination to develop personalized treatment.