23G玻璃体切割联合白内障超声乳化术治疗浅前房低角膜内皮细胞密度白内障患者的近期随访研究

A recent follow-up study of 23G vitrectomy combined with cataract phacoemulsification for patients with shallow anterior chamber cataract

目的探究23G玻璃体切割联合白内障超声乳化术治疗浅前房低角膜内皮细胞密度白内障患者的疗效。方法选取我院2018年1月~2019年5月收治的浅前房(中央前房深度<2.8mm)低角膜内皮细胞密度(角膜内皮细胞密度<1000/mm^(2))白内障患者64例(78眼),根据患者自愿原则,分为联合组(n=32例,40眼)和单纯超声乳化组(n=32例,38眼),单纯超声乳化组行白内障超声乳化手术治疗,联合组行23G玻璃体切割联合白内障超声乳化术治疗。比较2组手术前后视力变化、术后中央角膜厚度、角膜内皮丢失率、并发症情况。结果术后3d、1周联合组logMAR视力高于单纯超声乳化组(t_(1)=7.867,P1<0.05;t_(2)=9.904,P_(2)<0.05),术后3个月2组logMAR视力相比无显著差异(t=0.292,P=0.771);术后1周联合组中央角膜厚度高于单纯超声乳化组(t=5.178,P<0.001),术后3个月角膜内皮丢失率低于单纯超声乳化组(t=50.744,P<0.001);随访3个月2组均未出现严重并发症。结论相比单纯白内障超声乳化术,23G玻璃体切割联合白内障超声乳化术对角膜内皮细胞损伤更小,术后早期视力恢复更快,对于浅前房低角膜内皮细胞密度白内障患者,可根据病情和经济能力选择合适手术方式。

Objective To investigate the efficacy of 23 G vitrectomy combined with cataract phacoemulsification for patients with shallow anterior chamber cataract.Methods 64 patients(78 eyes)with low corneal endothelial cell density cataracts(corneal endothelial cell density<1000/mm^(2))were selected from our hospital from January 2018 to May 2019 with shallow anterior chamber(central anterior chamber depth<2.8 mm).According to the voluntary principle of patients,they were divided into a combined group(n=32 cases,40 eyes)and a phacoemulsification group(n=32 cases,38 eyes).Cataract phacoemulsification was performed in the phacoemulsification alone group,and 23 G vitrectomy combined with cataract phacoemulsification was performed in the combined group.The visual acuity changes before and after surgery,central corneal thickness after surgery,corneal endothelial loss rate,and complications of the two groups were compared.Results At 3 days and 1 week after operation,logMAR visual acuity was higher in the combined group than in the phacoemulsification group(t_(1)=7.867,P_(1)<0.05;t_(2)=9.904,P_(2)<0.05),there was no significant difference in logMAR vision between the 2 groups at 3 months after surgery(t=0.292,P=0.771);at 1 week after surgery,the central corneal thickness of the combined group was higher than that of the phacoemulsification group alone(t=5.178,P<0.001),the corneal endothelial loss rate at 3 months after surgery was lower than that in the phacoemulsification group(t=50.744,P<0.001);there was no serious complication in the 2 groups after 3 months of follow-up.Conclusion Compared with cataract phacoemulsification alone,23 G vitrectomy combined with cataract phacoemulsification has less damage to corneal endothelial cells,and early vision recovery after surgery is faster,for cataract patients with shallow anterior chamber and low corneal endothelial cell density,the appropriate surgical method can be selected according to the condition and economic ability.