超声乳化术中前房注射头孢呋辛对角膜内皮的影响

The effects of intracameral cefuroxime injection on corneal endothelium after cataract surgeries

目的通过对比超声乳化术中前房注射头孢呋辛(1mg/0.1ml)与否对角膜内皮的影响,以初步探讨前房注射头孢呋辛在白内障超声乳化手术中预防感染性眼内炎运用的安全性。方法本次研究共选择402例402眼白内障超声乳化手术患者,采用临床病例对照研究方法,将患者分为四组:无糖尿病未注药组、无糖尿病注药组、糖尿病未注药组、糖尿病注药组,对四组患者手术前后的角膜内皮六角形细胞比例、内皮细胞密度、变异系数等相关数据进行测量和记录,并对测量数据进行统计学分析。结果对比四组患者手术后1个月的角膜内皮细胞密度、六边形细胞比例,均低于术前,手术前后差异具有统计学意义(P<0.05);对比四组患者手术后1个月的角膜内皮细胞变异系数,明显高于术前,手术前后差异具有统计学意义(P<0.05)。术后1月糖尿病注药组对比其它三组,角膜内皮密度降低,角膜内皮细胞变异系数变大、六边形细胞比例下降,差异有统计学意义(P<0.05)。结论白内障超声乳化术对角膜内皮细胞有一定的损伤,合并有糖尿病的白内障患者超声乳化术中注射头孢呋辛后角膜内皮更容易受到损伤。对于糖尿病等内皮密度低,内皮形态异常的患者,白内障术中需谨慎前房注射头孢呋辛,使用过种中应严格准确配制剂量,避免过量注射引起的内皮损害。

Objetive To compare the effects of intracameral cefuroxime injection(1 mg/0.1 ml) on corneal endothelium after cataract surgeries, to evaluate the safety of intracameral cefuroxime injection on the prophylaxis of postoperative endophthalmitis after cataract surgeries.Methods Clinical case-control study was used.402( 402 eye) cataract patients were divided into 4 groups: no diabetes without cefuroxime injection group;No diabetes with cefuroxime injection group;diabetes without cefuroxime injection group;diabetes with cefuroxime injection group. The corneal endothelial cell density( CD),proportion of hexagonal cell and coefficient of variation( CV) in the 4 group patients were measured respectively before phacoemulsification and after surgery. And the measurement results were statistically analyzed.Results The corneal endothelial CD and proportion of hexagonal cell in the four group were decreased after surgery(P<0.05).But the CV of corneal endothelial cells was increased on the 1 st month after surgery(P<0.05).Compared with the other three groups, it was found that there was a decrease in the corneal endothelial CD, an increase in the CV of corneal endothelial cells and a decrease in the proportion of hexagonal cells(P<0.05) in the diabetes with cefuroxime injection group one month after surgery.Conclusion Phacoemulsification has some damage on the corneal endothelial.Cataract patients with diabetes mellitus are more vulnerable to corneal endothelium injury after cefuroxime injection during phacoemulsification. For Diabetic patients with low endothelial density and abnormal endothelial morphology, intracameral cefuroxime injection should be used with cautions in cataract surgery. The dose should be strictly and accurately formulated to avoid endothelial damage caused by excessive injection.