超声乳化术对高度近视合并白内障患者角膜内皮细胞的影响

Effect of Phacoemulsification on Corneal Endothelial Cells in Patients with High Myopia and Cataract

摘要: 目的：研究超声乳化术对高度近视合并白内障患者角膜内皮细胞的影响。方法：随机选择我院2017-1月至2017-10月期间白内障住院患者60例，其中高度近视合并白内障患者30例(高度近视组)，单纯年龄相关性白内障患者30例(非高度近视组)。患者接受白内障超声乳化摘除术联合人工晶体植入术，记录两组患者术前及术后1周、1月、3月角膜内皮细胞变异系数、角膜内皮细胞密度、平均角膜内皮细胞面积、六角形细胞百分比，对记录数据进行分析。结果：高度近视组和非高度近视组术前比较，角膜内皮细胞密度、平均角膜内皮细胞面积差异无统计学意义(P > 0.05)，高度近视组变异系数较大、六角形细胞百分比较小，差异均有统计学意义(P < 0.05)。术后组内比较，两组术后1周、1月、3月角膜内皮细胞变异系数、平均角膜内皮细胞面积均较术前增大，差异有统计学意义(P < 0.05)；角膜内皮细胞密度、六角形细胞百分比均较术前减小，差异有统计学意义(P < 0.05)。两组术后组间比较，高度近视组术后1周、1月、3月角膜内皮细胞变异系数、平均角膜内皮细胞面积较非高度近视组大，角膜内皮细胞密度、六角形细胞百分比较非高度近视组小，差异均有统计学意义(P < 0.05)。结论：高度近视合并白内障患者相对于单纯年龄相关性白内障患者角膜内皮细胞耐受力更差，更容易受到超声乳化手术的损伤，做好术前角膜内皮细胞功能的评估及术中术后角膜内皮的保护是减少并发症、提高术后视觉质量的关键。

Abstract: Aim: To study the effect of phacoemulsification on corneal endothelial cells in patients with high myopia and cataract. Methods: Sixty inpatients with cataract were randomly selected from January 2017 to October 2017 in our hospital, including thirty patients with high myopia and cataract (high myopia group) and thirty age-related cataract patients (non-high myopia group). Cataract phacoemulsification combined with intraocular lens implantation was performed on patients. The corneal endothelial cell coefficient of variation(CV), corneal endothelial cell density (CD), average area of corneal endothelial cells (AVG) and percentage of hexagonal cells (6A) were recorded before and 1 week, 1 month and 3 months after surgery. The recorded data were analyzed. Results: There was no significant difference in CD and AVG between the high myopia group and the non-high myopia group (P > 0.05). The high myopia group had larger CV and smaller 6A. The differences were statistically significant (P < 0.05). The CV and AVG in one week, one month and three months after operation were significantly increased compared with that before operation (P < 0.05). The CD and 6A were decreased compared with preoperative, and the difference was statistically significant (P < 0.05). Moreover, by comparing between the two groups after operation, it shows that the CV and AVG in the high myopia group at 1 week, 1 month and 3 months after operation were significantly higher than those in the non-high myopia group. Meanwhile, the CD and 6A were smaller in high myopia group. The differences were statistically significant (P < 0.05). Conclusion: Patients with high myopia and cataracts are less tolerant to corneal endothelial cells than those with age-related cataracts alone, and more susceptible to phacoemulsification surgery. The evaluation of corneal endothelial cells before operation and the protections of corneal endothelium in and after operation are the key to reduce complications and improve postoperative visual quality.