不同前房深度对白内障超声乳化手术角膜内皮的影响

Effect of different anterior chamber depth on corneal endothelium during phacoemulsification

目的观察不同前房深度对白内障超声乳化手术角膜内皮的影响。方法回顾性病例对照研究。比较不同前房深度对白内障超声乳化手术患者角膜内皮的影响。收集白内障患者40例(40只眼),按前房深度分为观察组(前房深度≥2.8 mm)和对照组(<2.8 mm),两组晶状体核分级3级(按Emery分级标准),两组患者均是同一白内障超声乳化治疗仪由同一术者实施手术。观察术后1 d及术后3个月两组患者的角膜内皮细胞计数、六角形细胞比率及角膜水肿情况。结果术前两组角膜内皮细胞计数及六角形细胞比率差异无统计学意义,两组术中超声能量的释放差异无统计学意义(P>0.05)。两组术后第1天角膜水肿发生率差异有统计学意义。术后3个月角膜内皮细胞计数采用均数±标准差比较,观察组术后3个月角膜内皮细胞计数(2483.55±278.10)个/mm^(2),对照组角膜内皮细胞计数(2133.50±221.28)个/mm^(2),差异有统计学意义(t=3.902,P=0.000)。两组术后3个月观察组六角形细胞比率(43.12±2.27),对照组六角形细胞比率(40.67±1.71),差异有统计学意义(t=3.581,P=0.000)。两组术中及术后均未发现严重并发症。结论白内障超声乳化摘除术中前房深度≥2.8 mm,增大了操作空间及距离,降低白内障手术角膜内皮细胞的损伤及术后早期角膜水肿率。

Objective To observe the effect of different anterior chamber depth on corneal endothelium after phacoemulsification.Methods A prospective case-control study.Forty patients with cataract who received phacoemulsification in our hospital were collected and divided into observation group(anterior chamber depth≥3.0mm)and control group(<3.0 mm).The classification of lens nuclei in both groups was grade 3 according to the Emery classification standard.The corneal endothelial cell count,hexagonal cell ratio and corneal edema were observed at 1 day and 3 months after the operation.Results There was no significant difference in the number of corneal endothelial cells and the ratio of hexagonal cells between the two groups before the operation.There was no significant difference in the release of ultrasonic energy between the two groups during the operation(P>0.05).The incidence of corneal edema at the first postoperative day was statistically different between the two groups.The corneal endothelial cell count at 3 months after operation was(2483.55±278.10)in the observation group and(2133.50±221.28)in the control group,and the difference was statistically significant(P<0.05,t=3.902,P=0.000).At 3 months after the operation,the ratio of hexagonal cells in the observation group was(43.12±2.27),and that in the control group was(40.67±1.71),with statistical difference(P<0.05,t=3.581,P=0.000).No serious complications were found in the two groups.Conclusions The anterior chamber depth≥3 mm during phacoemulsification can increase the operating space and distance,and reduce the damage of corneal endothelial cells and the rate of early postoperative corneal edema.