Corneal endothelial cell density and morphology in low and moderate myopic Chinese eyes

AIM:To describe and compare the corneal endothelial cell density and morphology in young,low and moderate myopic Chinese adults in Malaysian Chinese population.·METHODS:Non-contact specular microscopy(Topcon SP3000P,Tokyo,Japan) was performed in low(n =78;21.22±1.51 years) and moderate(n =78;21.82±1.40 years)myopic subjects.The mean of three consecutive measurements of endothelial cell density(MCD),coefficient of variation(CV) in the cell size,and hexagonal appearance of the cell were obtained.·RESULTS:In low myopic eyes the MCD was 3 063.0±176.2/mm2,the mean CV was 33.4 ±4.0% and the mean hexagonal appearance of the cell was 57.9 ±2.7%.In moderate myopic eyes the MCD was 2961.6 ±159.0/mm2,the mean CV was 33.9 ±3.6% and mean hexagonal appearance of the cell was 56.2 ±4.7%.There were statistically significant differences in MCD(P 【0.000) and hexagonal appearance of the cell(P 【0.005) between low and moderate myopic eyes.·CONCLUSION:The corneal endothelial cell layer in more myopic eyes tends to have less MCD and cell hexagonality compared to lower myopic eyes.Nevertheless,there is no significant difference in CV between low and moderate myopic eyes.

Corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome

AIM: To evaluate the corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome (PEX). METHODS: Medical records of 16 patients (20 eyes) with PEX who presented to our institution between July 2008 and June 2010 were retrospectively reviewed. Thirteen eyes had combined glaucoma. The information of five apparently normal fellow eyes in these patients was also recorded. Left eyes of 20 patients with bilateral senile cataracts but no other eye disease were included as controls. Specular microscopy was performed in all eyes to analyze for corneal endothelial cell density and morphology. Cell density, coefficient of variation in cell size, and percentage of hexagonal cells in corneal endothelium were evaluated. RESULTS: The mean corneal endothelial cell density in the PEX eyes was 2298+/- 239 cells/mm(2), significantly lower than that in the cataract eyes (2652+/- 18 cells/mm(2), P=0.026), but there were no significant differences in coefficient of variation of cell size and frequency of hexagonality between these two groups. No significant differences in the three parameters were found between the apparently normal fellow eyes and the PEX eyes or the cataract eyes, or between the PEX eyes with and without glaucoma. CONCLUSION: Corneal endothelial cell density may decrease in Chinese patients with PEX. The development of glaucoma in PEX eyes does not seem to be related with the change in corneal endothelial cell density or morphology.

Corneal endothelial cell density and morphology and central corneal thickness in Guangxi Maonan and Han adolescent students of China

AIM: To investigate the corneal endothelial cell density and morphology and central corneal thickness in the Guangxi Maonan and Han adolescent students of China.METHODS: Noncontact specular microscope(Topcon SP3000 P, Tokyo, Japan) was performed in 133 adolescent students of Maonan nationality(M:F 54:79)and 105 adolescent students of Han nationality(M:F 50:55),5 to 20 y of age, who were randomly selected from 3schools in Huanjiang Maonan Autonomous County of Guangxi Zhuang Autonomous Region of China.Parameters studied included endothelial cell density,mean cell area, coefficient of variation in cell size,percentage hexagonality and central corneal thickness. RESULTS: Endothelial cell density, mean cell area,coefficient of variation in cell size, percentage hexagonality and central corneal thickness in the study population were(2969.50 ±253.93) cells/mm2,(339.23 ±29.44) μm2,(29.96 ±4.07) %,(64.58 ±9.41) % and(523.71 ±32.82) μm in Maonan and(2998.26 ±262.65) cells/mm2,(336.11±30.07) μm2,(29.89±5.03) %,(64.91±11.64) % and(524.39 ±33.15) μm in Han, respectively. No significant differences were observed in endothelial cell density,mean cell area, coefficient of variation in cell size,percentage hexagonality and central corneal thickness between Maonan and Han(P =0.615, 0.659, 0.528, 0.551,0.999). In Maonan and Han, we found age was negatively correlated with endothelial cell density and percentagehexagonality and positively correlated with mean cell area and coefficient of variation in cell size. Negative correlation was also found between central corneal thickness and age in Han, whereas no correlation was found in Maonan. CONCLUSION: There were no differences between Maonan and Han in corneal endothelial cell density and morphology and central corneal thickness. In these two nationalities, there were statistically significant decrease in endothelial cell density and percentage hexagonality with increasing age and statistically significant increase in cell area and coefficient of variation in cell size with increasing age. Central corneal thinned with increasing age in Han, whereas difference did not attain statistical significance in Maonan.

Efficacy of ICL combined with Trans-PRK on corneal endothelial cell density in patients with high myopia

Objective:To explore the efficacy of implantable collamer lense (ICL) combined with laser keratectomy via corneal epithelium Trans-PRK in the treatment of patients with high myopia and its effect on corneal endothelial cell density.Methods: A prospective analysis was performed on patients with ultra-high myopia admitted to the department of ophthalmology of our hospital from March 2014 to March 2017. Six months after ICL implantation, the patients still had myopia and received Trans PRK treatment again. The number of cases was 30 and 52 eyes. Patients were followed up postoperatively. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), dioptre (D), intraocular pressure, ICL arch height, anterior chamber volume, anterior chamber depth, and changes in corneal endothelial cell counts were observed preoperatively, 6 months after ICL implantation and 6 months after Trans PRK so as to assess the effectiveness and safety of the surgery.Results: UCVA and BCVA of the eyes were significantly higher 6 months after ICL implantation and 6 months after Trans-PRK than those before the surgery, and UCVA of the eyes 6 months after Trans-PRK was significantly higher than that 6 months after ICL implantation. There was no increase in intraocular pressure in all patients after surgery. There was no significant difference in intraocular pressure preoperatively, 6 months after ICL implantation and 6 months after Trans PRK. The ICL arch height of the eyes 6 months after Trans-PRK was slightly lower than that 6 months after ICL implantation, but the difference was not statistically significant. Both anterior chamber volume and anterior chamber depth were significantly lower 6 months after ICL implantation and 6 months after Trans PRK than whose before the surgery, and anterior chamber depth 6 months after Trans PRK was significantly lower than that 6 months after ICL implantation. The number of corneal endothelial cells 6 months after ICL implantation was slightly less than that before surgery, but it was not statistically significant. The number of corneal endothelial cells 6 months after Trans PRK was higher than that 6 months after ICL implantation and close to the preoperative level.Conclusion: Trans PRK can effectively improve the eye diopter of patients with high myopia and residual myopia after ICL implantation. It has little effect on the density of corneal endothelial cells, can significantly improve visual acuity, and achieve the expected operation effect with safe operation, which is worthy of clinical promotion.

Destructive effects on endothelial cells of grafts in cytomegalovirus DNA-positive patients after keratoplasty

AIM:To investigate corneal graft survival rate and endothelial cell density(ECD)loss after keratoplasty in cytomegalovirus(CMV)positive patients.METHODS:This was a retrospective cohort study.We analyzed the clinical data of patients who underwent viral DNA detection in aqueous humor/corneal tissue collected during keratoplasty from March 2015 to December 2018 at the Peking University Third Hospital,Beijing,China.To further evaluate the effect of CMV on graft survival rate and ECD loss,patients were divided into three groups:1)CMV DNA positive(CMV+)group;2)viral DNA negative(virus-)group,comprising virus-group eyes pairwise matched to eyes in the CMV+group according to ocular comorbidities;3)control group,comprising virus-group eyes without ocular comorbidities.The follow-up indicators including graft survival rate,ECD,ECD loss,and central corneal thickness(CCT),were analyzed by Tukey honestly significant difference(HSD)test.RESULTS:Each group included 29 cases.The graft survival rate in CMV+group were lowest among the three groups(P=0.000).No significant difference in donor graft ECD was found among three groups(P=0.54).ECD in the CMV+group was lower than the virus-group at 12(P=0.009),and 24mo(P=0.002)after keratoplasties.Furthermore,ECD loss was higher in the CMV+group than in the virus-group in the middle stage(6-12mo)postkeratoplasty(P=0.017),and significantly higher in the early stage(0-6mo)in the virus-group than in the control group(P=0.000).CONCLUSION:CMV reduces the graft survival rate and exerts persistent detrimental effects on the ECD after keratoplasty.The graft ECD loss associate with CMV infection mainly occurrs in the middle stage(6-12mo postoperatively),while ocular comorbidities mainly affects ECD in the early stage(0-6mo postoperatively).

Visual acuity and endothelial cell density with respect to the graft thickness in Descemet's stripping automated endothelial keratoplasty: one year results

AIM: To evaluate the visual acuity and endothelial cell density according to the thickness in Descemet’s stripping automated endothelial keratoplasty(DSAEK)one year after surgery.METHODS: DSAEK patients’ data were reviewed. Thirty seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy(PBK) were included in this study. Graft thickness was measured with optical coherence tomography(OCT) 12 mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick(】200 μm), medium-thick(150-200 μm) and thin(【150 μm). Best corrected visual acuity(BCVA),endothelial cells density(ECD) and complications were assessed and comparisons were done between groups.RESULTS: Median thickness of postoperative grafts was 188(range 73-317 μm). There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12 mo,mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72 ±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts(P =0.001). Thick graft group had 1637.44 ±88.19-mm2,medium thick graft had 1764.50±34.28-mm2 and thin graft group had 1845.30 ±65.62-mm2. Thin graft group had better ECD at 12 mo after surgery(P =0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes withmedium-thick and thick grafts one year after surgery.

Differences in energy and corneal endothelium between femtosecond laser-assisted and conventional cataract surgeries：prospective,intraindividual,randomized controlled trial

AIM： To compare intraoperative phacoemulsification parameters and its effect on the corneal endothelium of eyes undergoing femtosecond laser-assisted cataract surgery（FLACS） versus conventional phacoemulsification（CP） cataract surgery.METHODS： Two hundred eyes from one hundred patients were included in a prospective, non-blinded, randomized, controlled, intraindividual clinical study. One hundred eyes underwent FLACS while their one hundred fellow eyes underwent CP. All surgeries were performed using the Victus？ femtosecond laser platform and Infinity？ Vision System phacoemulsification machine. Primary outcome measure was endothelial cell density 6 mo after surgery. Secondary outcome measures included central corneal thickness（CCT）, average cell area, standard deviation, coefficient of variation and hexagonality before surgery and 6 mo after surgery and endothelial cell density loss during this period were also evaluated. Intraoperative efficiency parameters [cumulative dissipated energy（CDE）, total intraocular surgery time, total ultrasound time, total phacoemulsification time, total torsional energy time, total aspiration time, ultrasound energy, torsional amplitude and fluid required during surgery] were also collated. RESULTS： Data from these patients was not considered for analysis. Data from 92 patients were analysed. Postoperative endothelial cell density（cells/mm2） between groups（2211.88±392.49 CP; 2246.31±403.48 FLACS） was not statistically significant（P=0.869）. Total ultrasound time, torsional energy time, CDE and fluid requirements were significantly lower the FLACS group（P〈0.05）. Other parameters did not show statistically significant difference between FLACS and CP.CONCLUSION： FLACS displays significant improvements in phacoemulsification parameters in comparison to CP. There are no significant differences in corneal endothelium measures between FLACS and CP.

多次玻璃体内注射抗VEGF药物对眼底血管性疾病患者角膜组织形态的影响

目的 探讨多次玻璃体内注射雷珠单抗和阿柏西普对湿性老年性黄斑变性(nAMD)、糖尿病黄斑水肿(DME)、视网膜静脉阻塞(RVO)患者角膜组织形态的影响。方法 前瞻性临床研究。选取2021年6月至2022年6月在我院眼内科注射中心治疗的患者共64例(64眼)作为研究对象;其中nAMD患者19例,DME患者20例,RVO患者25例。阿柏西普(40 g·L^(-1))治疗29例,雷珠单抗(10 g·L^(-1))治疗35例。所有入组病例均选取单眼注射,采取3+PRN的随访治疗方法。使用共聚焦显微镜行角膜神经检查,使用角膜内皮显微镜进行角膜厚度及角膜内皮细胞检查。比较nAMD、DME、RVO患者多次玻璃体内注射抗VEGF药物后角膜厚度、内皮细胞密度、变异系数、平均面积、六角形细胞比例、神经纤维长度、神经纤维密度,比较每次注射不同药物后1个月与基线时上述指标变化。结果 术前,DME组患者内皮细胞密度低于nAMD组和RVO组,DME组患者内皮细胞平均面积高于nAMD组和RVO组,差异均有统计学意义(均为P<0.05),三种不同疾病患者其余指标差异均无统计学意义(均为P>0.05)。注射抗VEGF药物3次后,DME组患者内皮细胞密度低于nAMD组和RVO组,内皮细胞平均面积高于nAMD组和RVO组,差异均有统计学意义(均为P<0.05);DME组患者神经纤维长度短于nAMD组和RVO组,差异均有统计学意义(均为P<0.05)。自从第2次注射阿柏西普后,nAMD组患者内皮细胞密度均较术前减少,差异均有统计学意义(均为P<0.05);每次注射后六角形细胞比例均较术前减少,差异均有统计学意义(均为P<0.05);其余指标注射后与术前相比,差异均无统计学意义(均为P>0.05)。自从第2次注射雷珠单抗后,RVO组患者内皮细胞密度均较术前减少,差异均有统计学意义(均为P<0.05)。结论 多次玻璃体内注射抗VEGF药物会一定程度降低角膜内皮六角形细胞比例及内皮细胞密度,注射药物后DME组的神经纤维长度显著低于nAMD组和RVO组。

深板层角膜移植与穿透性角膜移植治疗基质角膜营养不良预后的比较

背景:基质角膜营养不良的传统手术治疗方式为穿透性角膜移植,近年来越来越多的医生开始考虑使用深板层角膜移植治疗基质角膜营养不良。目前国内对比穿透性角膜移植和深板层角膜移植治疗基质角膜营养不良的研究少有报道。目的:比较深板层角膜移植和穿透性角膜移植治疗基质角膜营养不良的疗效。方法:选择2000年1月至2018年1月北部战区总医院收治的基质角膜营养不良患者57例(57眼),男18例,女39例,平均年龄(52.9±20.0)岁,按照手术治疗方式分为深板层角膜移植组(n=21)、穿性角膜移植组(n=36),术后随访观察最佳矫正视力、角膜内皮细胞密度、角膜植片透明度、术中及术后并发症、原病复发情况。结果与结论:①两组患者术后1,3,6,12个月的视力均高于术前(P<0.05),两组间术后不同时间点的视力比较差异无显著性意义(P>0.05);随着术后时间的延长,两组患者角膜内皮细胞密度逐渐降低,穿透性角膜移植组患者术后6,12个月的角膜内皮细胞密度年丢失率均高于深板层角膜移植组(P<0.05);两组患者术后12个月的角膜植片透明率比较差异无显著性意义(P>0.05);②深板层角膜移植组有6例出现并发症,穿透性角膜移植组有14例出现并发症,57例患者术后12个月内均无复发,两组患者术后5年的复发率比较差异无显著性意义(P>0.05),穿透性角膜移植组和深板层角膜移植组术后5年的移植物存活率分别为83%和86%,组间比较差异无显著性意义(P>0.05);③结果表明,基质角膜营养不良的治疗可考虑使用深板层角膜移植替代一部分穿透性角膜移植。

斑叉牙虾虎鱼(Apocryptodon punctatus)角膜上皮细胞扫描电镜形态观测

脊椎动物角膜上皮细胞在视觉成像中起着重要作用,针对鱼类角膜开展研究,能进一步揭示鱼类对不同水深环境,以及由水及陆进化过程中的视觉适应模式.笔者通过扫描电镜观察斑叉牙虾虎鱼(Apocryptodon punctatus)角膜上皮细胞,并统计密度、记录细胞类型及微结构,探究鱼类在进化过程中角膜的适应性进化模式.研究发现,斑叉牙虾虎鱼角膜上皮细胞是微嵴型细胞,角膜上皮细胞密度与微嵴间距之间无显著相关关系(p>0.05).角膜细胞密度整体平均值为(18106±1719)mm-2,角膜细胞的微嵴宽度平均值为(240±9)nm,角膜细胞的微嵴间距宽度平均值为(251±34)nm.结果表明:其角膜的演化出现了特异性的模式.该物种由于对水环境的依赖程度在背眼虾虎鱼亚科中较大,角膜上皮细胞仍保留了适应水生环境的特征.细胞密度和微嵴间距之间可能具有相互制约的关系.

飞秒激光辅助的超声乳化手术对小梁切除术后并发性白内障患者角膜的影响

目的比较飞秒激光辅助的超声乳化手术和常规超声乳化手术对小梁切除术后并发性白内障患者角膜的影响。方法前瞻性研究。选取我院2017年1月至12月收治的小梁切除术后并发性白内障患者100例100眼,利用随机数字表法将患眼分为两组,分别为行飞秒激光辅助的超声乳化手术的试验组和行常规超声乳化手术的对照组,每组各50例50眼。记录两组患者术前最佳矫正视力(best corrected visual acuity,BCVA)及术后裸眼视力(uncorrected visual acuity,UCVA)。用非接触角膜内皮显微镜(SP-2000P)分别于术前及术后1个月、3个月测量角膜内皮细胞密度(endothelial cell density,ECD);用Pentacam分析仪分别于术前及术后1 d、1个月、3个月测量中央角膜厚度(central corneal thickness,CCT)和角膜体积(corneal volume,CV)。对比两组术中各项超声参数及术后各指标间的差异。结果两组患者核硬度分级、手术时间、灌注液量相比,差异均无统计学意义(均为P>0.05)。两组间超声时间、超声能量、超声累积释放能量之间,差异均有统计学意义(均为P<0.05)。两组术后1 d UCVA相比差异有统计学意义(P=0.025),术前BCVA和术后1个月UCVA两组相比差异均无统计学意义(均为P>0.05)。术前两组患者的ECD、CCT、CV相比,差异均无统计学意义(均为P>0.05)。术后1个月、3个月两组间ECD相比差异均有统计学意义(均为P<0.05),但ECD减少率相比差异均无统计学意义(均为P>0.05)。术后1 d、1个月两组间CCT、CV相比差异均有统计学意义(均为P<0.05),而术后3个月两组间的CCT、CV相比差异均无统计学意义(均为P>0.05)。术后1 d、1个月,两组间CCT、CV增加率相比差异均有统计学意义(均为P<0.05)。术后3个月,两组患者的CCT、CV增加率相比差异均无统计学意义(均为P>0.05)。结论飞秒激光辅助的超声乳化手术能够减轻手术对角膜内皮细胞的损害,缩短角膜水肿恢复时间,降低术后角膜内皮失代偿的风险,提高小梁切除术后并发性白内障手术的安全性。

飞秒激光小切口角膜基质透镜取出术与准分子激光原位角膜磨镶术治疗近视对角膜内皮细胞密度影响的比较

目的比较飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)与准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视对角膜内皮细胞密度的影响。方法选取我院自愿接受SMILE手术和LASIK手术且常规术前检查确认为适应证的患者作为研究对象,接受SMILE手术者共93例(186眼)为观察组,接受LASIK手术者共96例(192眼)为对照组。比较两组患者手术前后视力、眼压和中央角膜厚度的变化情况,并于术前和术后1 d、10 d、1个月、3个月、6个月进行角膜内皮细胞计数仪检查,观察并统计分析两组患者角膜内皮细胞密度、变异系数、六角形细胞百分比、平均细胞面积。结果手术后两组患者各时间点裸眼视力差异均无统计学意义(均为P>0.05);术后1个月,观察组眼压和中央角膜厚度改变率分别为(-27.10±11.20)%和(-14.50±4.30)%,对照组分别为(-29.20±9.60)%和(-17.90±4.30)%,观察组眼压和中央角膜厚度改变率均较对照组低(均为P<0.05)。术后6个月,观察组眼压和中央角膜厚度改变率分别为(-24.50±10.90)%和(-13.60±4.30)%,对照组分别为(-27.00±10.80)%和(-15.60±4.40)%,较术后1个月时有所减少(均为P<0.05),说明眼压和中央角膜厚度有一定回升趋势;角膜内皮细胞密度、平均细胞面积、变异系数及六角形细胞百分比两组患者手术前后各时间点比较差异均无统计学意义(均为P>0.05),组间各时间点比较差异均无统计学意义(均为P>0.05)。结论 SMILE与LASIK治疗近视均具有较高的安全性、有效性和稳定性。与LASIK相比,SMILE术后角膜弹性的改变较少,角膜内皮细胞密度无明显变化,不会对角膜内皮细胞造成过重损伤。

组织工程人角膜内皮的体外重建及其形态结构

目的:组织工程人角膜内皮(tissue-engineered human corneal endothelia,TE-HCE)的体外重建及其形态结构。方法:用有限稀释法从HCE细胞系筛选出单克隆细胞(mcHCE细胞),用常规染色体标本制作和核型分类学方法进行核型分析。用羊膜的胰酶倒置消化和细胞外基质蛋白包被方法制备去上皮层修饰羊膜(mdAM)。以核型正常的对数期mcHCE细胞为种子细胞,以平铺于24孔培养板孔底的mdAM为载体支架,用200mL/L胎牛血清-DMEM/F12培养液在37℃,50mL/LCO2培养箱中进行TE-HCE的体外重建。用茜素红染色、冰冻切片HE染色、倒置显微镜和扫描电镜观察种子细胞的形态、细胞连接的形成情况、细胞单层的完整性及其与mdAM结合的紧密程度。用透射电镜方法鉴定种子细胞的超微结构以及细胞连接的形成情况。用免疫荧光技术检测种子细胞对不同细胞连接蛋白的表达模式。结果:从非转染HCE细胞系中筛选出了7个核型正常(2n=46)的单克隆细胞株。在启动重建30h后,mcHCE种子细胞在mdAM上形成了完整的细胞单层,细胞密度高达3413/mm2。HCE细胞呈多角形细胞形态,形成了完整的细胞单层,且在细胞-细胞以及细胞-mdAM间形成了多种细胞连接,种子细胞在超微结构上与在体HCE细胞类似,胞质中含有许多线粒体,并具有紧密连接蛋白-1、钙黏蛋白、间隙连接蛋白-43和整联蛋白αv/β5的阳性表达。结论:体外重建的TE-HCE在结构和功能上与在体HCE相似,有望作为HCE的替代物用于临床角膜内皮移植。

高血压患者角膜内皮细胞形态学的研究分析

目的:探讨原发性高血压病对角膜内皮的影响。方法:应用全自动角膜内皮细胞分析仪对296例348眼进行角膜厚度及内皮细胞形态检测。原发性高血压患者148例173眼,其中A组(Ⅰ、Ⅱ期)87例104眼,B组(Ⅲ、Ⅳ期)61例69眼;正常对照组148例175眼。各组之间年龄、性别差异无统计学意义,且均排除其他全身疾病史。对各组角膜内皮细胞的平均密度、六边形细胞比例、变异系数及中央角膜厚度进行统计学分析。结果:高血压组患者较正常对照组角膜内皮细胞变异系数和中央角膜厚度增加,六边形细胞比例以及中央角膜内皮细胞密度减少,差异具有统计学意义(P<0.05或P<0.01);高血压B组与高血压A组相比较4项指标之间差异均有统计学意义(P<0.05或P<0.01)。结论:原发性高血压患者角膜内皮细胞形态结构存在异常,且随病变程度的加重而加重。对合并患有高血压的患者在进行内眼手术时应特别注意保护角膜内皮,防止角膜内皮功能失代偿。

白内障超声乳化术后早期区域性角膜水肿的临床研究

目的探讨白内障超声乳化术后早期区域性角膜水肿的临床特征。方法收集行白内障超声乳化联合人工晶体植入术的患者50例(50只眼)。采用角膜内皮显微镜(corneal specular microscope,CSM)对手术前后角膜中央、12点、3点、6点及9点位的5个象限,每一象限的5个区域总共25个位置的角膜内皮细胞(corneal endothelial cells,CECs)进行拍照、图像合并及数字化分析。采用眼前节光学相干断层扫描仪(anterior segment optical coherence tomography,AS-OCT)获取白内障手术前后全角膜厚度图,分析区域性角膜水肿与区域性CECs密度(corneal endothelial cell density,CD)改变的相关性。结果入组50例手术均顺利实施,随访期(12.5±1.1)个月。5个象限共25个位置CEC数据显示:术后1 d,平均CD为(2 045±153)个/mm2,较术前平均(2 557±265)个/mm2差异有统计学意义(P<0.01)。与中央区参数相比,12、3、6、9点位CD差异均存在统计学意义(P<0.01)。术后1 d,在中央、12、6、9、3点位,角膜厚度变化分别为(162.7±84.8)、(285.1±114.5)、(121.1±91.2)、(257.2±123.4)、(145.1±91.4)μm,均较术前增加(P均<0.01)。术后1 d,区域性CD减少与区域性角膜水肿存在正相关(r=0.87,P=0.001)。结论白内障术后区域性的角膜厚度增加可间接反映区域性CD减少的程度。

ICL联合Trans-PRK治疗超高度近视患者的疗效及对角膜内皮细胞密度的影响

目的:探索可植入式隐形眼镜(implantablecollamerlense,ICL)联合经角膜上皮激光角膜切削术(laser keratectomy via corneal epithelium,Trans-PRK)治疗超高度近视患者的疗效及对角膜内皮细胞密度(corneal endothelial cell density)的影响。方法:分析研究本院眼科2014年3月~2017年3月期间收治的超高度近视患者,在接受ICL植入术后6个月仍残留近视并再次接受Trans-PRK治疗,病例数为30例52眼。术后对患者进行随访,于术前、ICL植入术后6个月、Trans-PRK术后6个月观察裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、屈光度(dioptre,D)、眼压(intraocular pressure)、ICL拱高(arch height)、前房容积(anterior chamber volume)、前房深度(anterior chamber depth)以及角膜内皮细胞数变化情况,以此评价手术的有效性及安全性。结果: ICL植入术后6个月、Trans-PRK术后6个月术眼UCVA、BCVA均明显高于术前( P =0.000),且Trans-PRK术后6个月术眼UCVA明显高于ICL植入术后6个月( P <0.05);所有患者术后均未出现眼压增高的情况,术前、ICL植入术后6个月及Trans-PRK术后6个月术眼眼压差异无统计学意义( P >0.05),Trans-PRK术后6个月术眼ICL拱高稍低于ICL植入术后6个月,但差异无统计学意义( P >0.05);ICL植入术后6个月、Trans-PRK术后6个月术眼前房容积、前房深度均明显小于术前( P =0.000),且Trans-PRK术后6个月前房深度明显低于ICL植入术后6个月( P <0.05);ICL植入术后6个月术眼角膜内皮细胞数略少于术前,差异不具有统计学意义( P >0.05),Trans-PRK术后6个月角膜内皮细胞数较ICL植入术后6个月有所回升,接近术前水平。结论: Trans-PRK治疗可有效改善高度近视ICL植入术后残留近视患者眼球的屈光度,对角膜内皮细胞密度影响小,显著提升视力水平,提升视力水平,达到预期手术效果,且操作安全,值得临床推广。

闭角型青光眼患者急性发作时角膜内皮细胞形态特征分析

目的观察闭角型青光眼患者急性发作时角膜内皮细胞形态特征,以进一步探讨短期急性高眼压对角膜内皮细胞的损害机制。方法收集闭角型青光眼初次急性发作、发作持续时间在3d以内的患者20例20眼,选取老年性白内障患者20例20眼作为对照组。2组患者分别进行非接触型角膜内皮显微镜检查,比较2组患者的角膜内皮细胞最小细胞面积、最大细胞面积、平均细胞面积、细胞面积标准差、细胞面积变异系数、细胞密度和六角形细胞比例有无差异。结果青光眼急性发作组和对照组患者的角膜内皮细胞最小细胞面积、最大细胞面积、平均细胞面积、细胞面积标准差、细胞面积变异系数、细胞密度相比,差异均无统计学意义(均为P>0.05)。青光眼急性发作组角膜内皮细胞六角形比例为(48.0±13.9)%,对照组为(58.0±6.7)%,2组比较差异有显著统计学意义(t=-2.91,P=0.006)。结论短期持续高眼压会首先导致角膜内皮细胞的形状发生改变,而其他测量指标可能维持不变。

晶状体在玻璃体切割手术中对角膜内皮损伤的防范作用

目的 探讨晶状体在玻璃体切割手术中对角膜内皮损伤的防范作用。方法 对 5 6例 ( 5 6眼 )患者分别行单纯玻璃体切割术、玻璃体切割联合六氟化硫 (SF6)填充术、玻璃体切割联合硅油填充术及玻璃体切割 +晶状体切割联合硅油填充术。测定手术前和手术后 2周角膜内皮细胞的密度。结果 玻璃体视网膜手术可以引起角膜内皮细胞密度的下降。玻璃体切割 +晶状体切割联合硅油填充术引起角膜内皮细胞密度下降 ( 2 4 79%± 10 90 % ) ,与其他各组相比差异有显著性 (P <0 0 1)。结论 在玻璃体视网膜手术中保留晶状体对保护角膜内皮有重要意义。

三种角膜屈光手术对近视患者角膜内皮细胞的影响

目的:对比角膜板层刀制瓣的前弹力层下准分子激光角膜磨镶术(SBK)、飞秒激光制瓣的SBK术(FS-SBK)与飞秒激光小切口角膜基质透镜取出术(SMILE)对近视中央角膜内皮细胞的短期及长期影响。方法:我院近视34例34眼行SBK术;41例41眼行FS-SBK术;49例49眼行SMILE术,术前和术后1wk,1a利用SP-1P型非接触角膜内皮显微镜检查角膜内皮细胞,统计分析各组中央角膜内皮细胞密度(ECD)、内皮细胞面积的变异系数(CV)和六边形内皮细胞百分比。结果:三组间术前、术后1wk,1a裸眼视力及屈光度均无差异(P>0.05)。术后1wk三组中央ECD均较术前减少(P<0.01),术后1a各组均较术前无差异(P>0.05);术前及术后各随访时间点,三组间中央角膜内皮细胞面积CV及六边形内皮细胞百分比均无差异(P>0.05);不同组内,术前及术后各随访时间点结果均无差异(P>0.05)。结论:SBK、FS-SBK和SMILE手术对近视内皮细胞的安全性确切,术后早期各组中央角膜ECD均轻度降低,1a后恢复;术后各组中央角膜内皮细胞面积CV及六边形内皮细胞百分比较术前无明显改变。

DSAEK手术植片厚度和大小对角膜内皮细胞密度的远期影响

目的探讨角膜后弹力层剥除联合自动角膜刀取材内皮移植术(DSAEK)供体中央植片厚度(CGT)和大小对角膜内皮细胞密度(ECD)的远期影响。方法采用系列病例观察研究,收集2013年1月至2017年12月因角膜内皮功能失代偿在北京大学第三医院眼科中心接受DSAEK手术并严格完成2年或以上随访的患者134例144眼。采用角膜内皮镜测量术前供体ECD;术后1、3、6、12和24个月,采用激光扫描共聚焦显微镜测量术后ECD,计算角膜内皮细胞丢失率;采用眼前节光相干断层扫描仪测量供体CGT。根据术后3个月供体CGT将患者分为薄植片组45眼、中等厚植片组66眼和厚植片组33眼,分别为供体CGT<100μm、≥100~<150μm和≥150μm。根据角膜环钻切割的供体植片大小将患者分为小植片组31眼和大植片组113眼,分别为供体植片直径≥7~<8 mm和≥8~<9 mm。比较手术后供体CGT变化及术后不同时间点角膜内皮细胞丢失率;分析术后24个月ECD与术前供体植片ECD、大小及CGT的相关性。结果术后1、3、6、12和24个月供体CGT分别为129.0(90.8,160.8)、115.5(93.0,146.0)、115.5(89.0,151.0)、112.5(94.3,146.8)和114.0(89.0,144.5)μm,总体比较差异有统计学意义(H=37.369,P<0.001),其中术后1个月供体CGT与术后3个月相比差异有统计学意义(P<0.001)。术后1、3、6、12、24个月,薄植片组、中等厚植片组和厚植片组以及大植片组、小植片组角膜内皮细胞丢失率比较差异均无统计学意义(均P>0.05)。Spearman相关性分析显示,术后24个月时ECD与术前供体植片ECD呈强正相关(r_(s)=0.783,P<0.001),与供体植片大小和CGT均无明显相关性(r_(s)=0.141,P=0.093;r_(s)=-0.044,P=0.600)。结论术前供体植片ECD越大,术后ECD越大;供体植片越薄、直径越大,DSAEK术后远期角膜内皮细胞丢失率越低。