摘要
目的探讨双切口囊外白内障摘除术(ECCE)治疗低角膜内皮细胞数的硬核白内障的疗效及安全性。方法病例对照研究。收集2009年6月至2018年12月于山东省眼科医院就诊的角膜内皮细胞数低的硬核白内障患者46例(47只眼),其中男性22例,女性24例,年龄(63.8±6.3)岁。入选标准:患者术前角膜内皮细胞计数<1000个/mm2且白内障核硬度≥Ⅳ级。根据ECCE手术方法分为两组:单切口组(24只眼),双切口组(23只眼)。双切口组手术方法为:采取先行上方巩膜预切口,从颞侧或鼻侧2.6 mm透明角膜隧道切口完成常规撕囊,水分离,切开上方巩膜切口,娩出晶体核,巩膜切口缝合,从角膜切口灌吸残余皮质,折叠式人工晶状体植入,吸除黏弹剂。观察术中前房维持情况,术后角膜水肿情况。术后随访6个月,对比两组角膜内皮计数及视力、散光情况。采用χ^2检验对计数资料、t检验对计量数据进行比较。结果两组患者年龄、术前视力、核硬度分级等差异均无统计学意义(P>0.05)。双切口与单切口组患者术前角膜内皮细胞计数分别为(827±164)和(802±121)个/mm^2,差异无统计学意义(t=1.12,P=0.28)。术后6个月双切口组与单切口组患者角膜内皮细胞计数分别为(793±147)和(706±101)个/mm2,差异有统计学意义(t=4.37,P<0.01);角膜内皮细胞丢失率分别为4.16%±3.12%和11.69%±2.96%,差异亦有统计学意义(t=9.52,P<0.01);角膜内皮六边形细胞比例分别为9.67%±6.11%和28.33%±8.39%,差异有统计学意义(t=5.52,P<0.05)。随访6个月,双切口组所有患者均未出现角膜内皮功能失代偿,单切口组3只眼出现角膜大泡、角膜内皮功能失代偿。两组患者术后散光度数和术源性散光度数差异均无统计学意义(t=-0.71,0.15;P>0.05)。结论采用巩膜大切口娩出硬核联合角膜隧道切口完成其余手术步骤的双切口ECCE,对低角膜内皮细胞数硬核白内障是安全、有效的手术治疗方式。
Objective To discuss the efficacy and security of double-incision extracapsular cataract extraction(ECCE)in the treatment of hard-nucleus cataract with low corneal endothelial cell density.Methods This was a retrospective case series study.Forty-six patients(47 eyes)with hard-nucleus cataract and low corneal endothelial cell density were enrolled at Shandong Eye Hospital from June 2009 to December 2018,including 22 males and 24 females,aged 50 to 74(63.8±6.3)years.Preoperative corneal endothelial cell density was less than 1000 cells/mm2,and the cataract nuclear hardness was equal to or greater than grade IV.According to the surgical methods,the patients were divided into the single-incision ECCE group(24 eyes)and the double-incision ECCE group(23 eyes).The surgical procedures for the double-incision group were as follows.First,a superior scleral pre-incision was made.Then the conventional capsulorhexis was conducted through a 2.6 mm transparent corneal tunnel incision at the temporal or the nasal side,after which the hydro-dissection was performed.Next,the surgeon cut the pre-incision at the sclera,delivered the lens nucleus,sutured the scleral incision and removed the residual cortical materials from the corneal incision.Finally,a foldable intraocular lens was implanted,and the viscoelastic substance was removed.The intraoperative anterior chamber condition and the postoperative corneal edema condition were monitored.During the 6 month follow-up after surgeries,the endothelium cell density,visual acuity and astigmatism in the two groups were compared.Theχ^2 test was used to compare the counting data,and the t test was used to compare the measurement data.Results There was no statistically significant difference(t=1.12,P=0.28)in the preoperative corneal endothelial cell density between the double-incision and single-incision ECCE groups,which was(827±164)cells/mm2 and(802±121)cells/mm^2,respectively.At 6 months after operation,in the double-incision and single-incision groups,the endothelial cell density was(793±147)cells/mm2 and(706±101)cells/mm2,respectively,and the difference was statistically significant(t=4.37,P<0.01).The percentage of corneal endothelial cell loss was 4.16%±3.12%and 11.69%±2.96%,respectively,and the difference was also statistically significant(t=9.52,P<0.01).The hexagon loss rate of corneal endothelial cells was 9.67%±6.11%and 28.33%±8.39%,respectively,and the difference was statistically significant(t=5.52,P<0.05).In the follow-up of 6 months,none of the eyes in the double-incision ECCE group suffered corneal endothelial decompensation compared with 3 eyes in the single-incision ECCE group.There were no statistically significant differences in postoperative astigmatism and surgically induced astigmatism between the two groups(t=-0.71,0.15;P>0.05).Conclusions The double-incision ECCE,in which the lens nucleus is delivered through a scleral incision and other procedures are conducted through a corneal tunnel incision,is safe and effective for cataract patients with hard nucleus and low corneal endothelial cell density.
作者
江音
史伟云
李凤洁
王婷
Jiang Yin;Shi Weiyun;Li Fengjie;Wang Ting(Shandong Eye Hospital,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250021,China;Department of Ophthalmology,Anqing Hospital,Anqing 246004,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2020年第2期126-130,共5页
Chinese Journal of Ophthalmology
基金
国家自然科学基金(81530027)
山东省自然科学基金(ZR2019MH135)。
关键词
白内障摘除术
内皮
角膜
角膜内皮细胞丧失
Cataract extraction
Endothelium
corneal
Corneal endothelial cell loss
