Centurion超声乳化系统在高度近视眼白内障术后对角膜内皮细胞的影响

Related Influencing Factors of Centurion Phacoemulsification System on Corneal Endothelial Cells after Cataract Surgery of High Myopia

目的通过多因素分析统计模型寻找Centurion超声乳化系统在高度近视眼白内障治疗中影响角膜内皮细胞的相对高危因素。方法选择2019年1月—2020年11月在本院行高度近视眼白内障手术的患者为研究对象,将眼轴>26mm的81例工作归入研究组,将眼轴≤26mm的81例患者归入对照组,均用Centurion超声乳化手术系统行白内障超声乳化+人工晶体植入手术。采用非接触角膜内皮显微镜于术前及术后7d、1个月、3个月时检查两组术眼角膜内皮细胞密度和六角形细胞的比例,收集患者一般资料、核硬度、累积超声能量、超声乳化时间、眼轴等,观察Centurion超声乳化系统在高度近视眼白内障术后角膜内皮细胞影响的相关因素。结果研究组术前和术后7d、1个月、3个月的角膜内皮细胞密度分别为(2585.78±413.39)个/mm^(2)、(2524.39±457.56)个/mm^(2)、(2424.39±517.34)个/mm^(2)、(2333.39±513.78)个/mm^(2),六角细胞比例分别为(53.04±9.68)%、(49.82±9.39)%、(48.14±9.17)%,(48.04±8.8)8%。对照组术前和术后7d、1个月、3个月的角膜内皮细胞密度分别为(2681.77±454.3)7个/mm^(2)、(2527.31±460.56)个/mm^(2)、(2521.45±489.67)个/mm^(2)、(2433.47±504.74)个/mm^(2),六角细胞比例分别为(55.01±8.68)%、(50.12±8.39)%、(49.14±9.45)%、(48.54±7.87)%。与研究组和对照组术前相比,术后7d、1个月、3个月角膜内皮细胞密度明显下降、六角细胞比例有所减少。对比研究发现对角膜内皮细胞影响因素最强的是核硬度(P=0.000),其次是累积超声能量(CDE)(P=0.035),再次是超声乳化时间(P=0.041),最后是眼轴(P=0.048),差异有统计学意义(P<0.05)。结论在Centurion超声乳化手术系统下高度近视白内障的晶状体核硬度、累积超声能量大小、超声乳化时间长短以及眼轴长度是导致角膜内皮细胞损伤的主要危险因素,因此提高手术熟练程度,提升手术技巧,减少手术时间,减少超乳能量,能够有效减少对角膜内皮细胞的损害。

Objective To identify relatively high-risk factors of centurion phacoemulsification system affecting corneal endothelial cells in treatment of high myopia cataracts based on multivariate analysis statistical model.Methods The paper chose patients with high myopia cataract surgery in our hospital from January 2019 to November 2020,81 patients with eye axis greater than 26mm were included in study group,and 81 patients with eye axis≤26mm in control group,treated with cataract phacoemulsification and intraocular lens implantation with centurion phacoemulsification system.Density of corneal endothelial cells and proportion of hexagonal cells was examined between two groups of eyes before and 7 days after surgery,at 1 month and 3 months with non contact corneal endothelial microscopy.General patient information,nuclear hardness,cumulative ultrasound energy,phacoemulsification time,eye axis,etc.was collected to observe relevant factors of centurion phacoemulsification system on corneal endothelial cells after high myopia cataract surgery.Results Density of corneal endothelial cells in study group was(2585.78±413.39)/mm^(2),(2524.39±457.56)/mm^(2),(2424.39±517.34)/mm^(2),and(2333.39±513.78)/mm^(2) before and 7 days,1 month,and 3 months after surgery respectively.Proportion of hexagonal cells was(53.04±9.68)%,(49.82±9.39)%,(48.14±9.17)%,and(48.04±8.8)8%.Density of corneal endothelial cells in control group was(2681.77±454.37)/mm^(2),(2527.31±460.56)/mm^(2),(2521.45±489.67)/mm^(2),and(2433.47±504.74)/mm^(2) before and 7 days,1 month,and 3 months after surgery respectively.Proportion of hexagonal cells was(55.01±8.68)%,(50.12±8.39)%,(49.14±9.45)%,and(48.54±7.87)%.Before surgery,corneal endothelial cell density significantly decreased and proportion of hexagonal cells decreased 7 days,1 month,and 3 months after surgery between two groups.Comparative studies showed,the strongest influencing factor on corneal endothelial cells were nuclear hardness(P=0.000),cumulative ultrasound energy(CDE)(P=0.035),phacoemulsification time(P=0.041),and finally eye axis(P=0.048),with statistically significant difference(P<0.05).Conclusion:Under centurion phacoemulsification system,main risk factors for corneal endothelial cell damage include hardness of lens nucleus,accumulated ultrasound energy,phacoemulsification time,and axial length of highly myopic cataracts.Therefore,improving surgical proficiency,hand skills,reducing surgical time and phacoemulsification energy can reduce damage to corneal endothelial cells effectively.