抗青术后白内障行Phaco后角膜内皮和形态学参数的变化

Change of corneal endothelial and corneal topography parameters after cataract phacoemulsification in eyes after antiglaucoma surgery

摘要:

目的:比较抗青光眼术后白内障眼和正常白内障眼行超声乳化手术后角膜内皮和角膜形态学参数的变化。方法:前瞻性系列病例研究。 我院2010-01/12行白内障超声乳化患者160例200眼,其中包括抗青光眼术后白内障和正常眼白内障各100眼。以抗青光眼术后白内障作为实验组,正常眼白内障作为对照组。用非接触角膜内皮显微镜（SP-2000P）分别于术前,术后1, 3mo测量角膜内皮密度（endothelial cell density,ECD）；用Pentacam分析仪分别于术前,术后1,3mo测量角膜形态学参数,包括角膜中央厚度（central corneal thinkness,CCT）和角膜体积（corneal volume,CV）。结果:术前实验组平均的ECD（1203±245个/mm²）比对照组（2648±167个/mm²）小（P＜0.01）,而实验组的平均CCT（543±32μm）值较对照组（525±36μm）大（P＜0.01）,实验组的平均CV(59.14±2.79mm³)值较对照组（57.26±3.24mm³）大（P＜0.05）,有统计学意义。术后1,3mo实验组平均的ECD较对照组明显减少（P＜0.01）,而CCT值较对照组明显增加（P＜0.01）,CV值较对照组也明显增加（P₁＜0.01,P₂＜0.05）,有统计学意义。术后1,3mo角膜内皮细胞丢失百分率（％）在实验组比对照组大（P₁=0.1145,P₂=0.2018),但无统计学意义。CCT值增加百分率（％）实验组比对照组在1mo时要显著增加（P=0.0142）,有统计学意义,而在3mo时两者无明显差异（P=0.3562）。CV值增加百分率（％）实验组比对照组在1mo时要显著增加（P=0.0134）,有统计学意义,而在3mo时两者无明显差异（P=0.4538）。结论:抗青光眼术后白内障眼术前ECD较正常眼低,行白内障超声乳化手术术后的角膜内皮细胞丢失率比正常眼要大,术后短期角膜水肿较正常眼严重,所以抗青光眼术后白内障眼只有更精密的规划手术和更精细的手术操作,才能在术中尽量减少对内皮细胞的损害,缩短角膜水肿恢复的时间,降低术后角膜内皮失代偿的风险。

Abstract:

AIM:To compare the change of corneal endothelial cell density (ECD) and topography parameters after cataract phacoemulsification in eyes after antiglaucoma surgery and normal eyes.METHODS:Form January 2010 to December 2010, 200 eyes after phacoemulsification were divided into experimental group (after glaucoma surgery group) and control group (normal eye group) with 100 in each group. The ECD and topography parameters, including central corneal thickness (CCT) and corneal volume(CV), were examined preoperatively and 1 month and 3 months after surgery.RESULTS:Preoperatively, the mean ECD inexperimental group(1203±245/mm²) was significantly lower than that in control group(2648±167/mm², P<0.01), and the CCT and CV in experimental group(543±32μm and 59.14±2.79mm³) were significantly greater than those in control group(525±36μm and 57.26±3.24mm³; P<0.01, P＜0.05, respectively). One month and 3 months postoperatively, the mean ECD was significantly less while the CCT and CV were significantly greater in experimental group than those in control group(P＜0.01). However, no significant difference in the percentage of cell loss was found between groups at 1 or 3 months(P=0.1145, P=0.2018, respectively). The percentage increase in CCT and CV was significantly greater in experimental group than control group in 1 month(P=0.0142, P=0.0134, respectively), although there was no significant difference at 3 months(P=0.3562,P=0.4538, respectively).CONCLUSION:More sophisticated surgery and more refined surgical procedures are needed to minimize the damage to endothelial cells, and shorten the recovery time of corneal edema, and reduce the risk of corneal endothelial decompensation in cataract eyes after antiglaucoma surgery.