飞秒激光辅助白内障手术后患者远期视力恢复情况角膜内皮细胞变化及相关因素探讨

Long-term Visual Recovery,Changes of Corneal Endothelial Cells and Related Factors in Patients with Cataract Surgery Assisted by Femtosecond Laser

目的:探头飞秒激光辅助白内障手术治疗后患者远期视力恢复情况,角膜内皮细胞变化与相关影响因素。方法:选取我院2015年8月至2017年7月行飞秒激光辅助白内障手术患者73例作为研究对象,观察患者术前、术后1d、术后1周、术后1个月、术后6个月视力、角膜内皮细胞计数变化情况;根据角膜内皮细胞丢失情况进行分组,分为严重丢失组与一般丢失组,首先采用单因素分析,将具有统计学意义的变量,纳入Logistic回归中,分析导致严重角膜内皮细胞丢失的危险因素。结果:各时点裸眼近视、裸眼远视、角膜内皮细胞计数比较,差异具有统计学意义(P<0.05);其中术后1周、术后1个月、术后6个月裸眼近视、裸眼远视视力显著高于手术前,术后1周显著高于术后1d、术后1个月显著高于术后1d、术后1周;术后6个月显著高于术后1d、术后1周、术后1个月、术后6个月,差异具有统计学意义(P<0.05)。术后出现角膜内皮细胞严重丢失者40例,一般丢失者33例;根据单因素分析显示:角膜中央内皮细胞严重丢失与一般丢失患者中,年龄、术前晶状体核硬度分级、术前前房深度、术前眼轴长度,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示:年龄、术前晶状体核硬度分级、术前前房深度、术前眼轴长度是导致患者角膜严重丢失的影响因素与独立危险因素,差异具有统计学意义(P<0.05)。结论:飞秒激光辅助白内障手术可改善患者视力,但患者存在角膜丢失情况,年龄、术前晶状体核硬度分级、术前前房深度、术前眼轴长度是导致患者角膜严重丢失的影响因素与独立危险因素,临床中对于该类型患者需格外留意。

Objective:To investigate the long-term vision recovery,corneal cell changes and related influencing factors after femtosecond laser assisted cataract surgery.Methods:73 cases of cataract patients who underwent femtosecond laser assisted cataract surgery in our hospital from August 2015 to July 2017 were selected as the research objects.The changes of visual acuity and corneal endothelial cell count were observed before operation,1 day after operation,1 week after operation,1 month after operation and 6 months after operation;According to the loss of corneal endothelial cells,they were divided into severe loss group and general loss group.Firstly,the variables with statistical significance were included in logistic regression and the univariate analysis was used to analyze the risk factors of severe corneal endothelial cell loss.Results:There were significant differences in myopia,hyperopia and corneal endothelial cell count at different time points(P<0.05).The visual acuity of naked myopia and naked hyperopia at 1 week,1 month and 6 months after operation was significantly higher than that before operation.1 week after operation was significantly higher than 1 day after operation.1 month after operation was significantly higher than 1 day and 1 week after operation.6 months after operation was significantly higher than 1 day,1 week,1 month and 6 months after operation,the difference was statistically significant(P<0.05).Conclusion:Femtosecond laser-assisted cataract surgery can improve the visual acuity of patients,but there is corneal loss in patients.Age,preoperative lens nucleus hardness grade,preoperative anterior chamber depth and preoperative axial length are the influencing factors and independent risk factors of severe corneal loss,which should be paid special attention to in clinical.