白内障超声乳化人工晶体植入术对角膜内皮细胞损伤的危险因素分析

Risk Factors of Corneal Endothelial Cell Injury after Phacoemulsification and Intraocular Lens Implantation

摘要: 目的：探讨白内障患者超声乳化人工晶体植入术对角膜内皮细胞损伤的危险因素。方法：回顾性分析我院眼科2018年1月~2018年12月行超声乳化白内障摘除人工晶状体植入术的216例患者(278只眼)。观察其术前和术后1 wk、1 mo、2 mo、3 mo角膜内皮细胞密度、六角形细胞百分比，并应用多元Logistic回归分析角膜内皮细胞损伤的危险因素。结果：术后1 wk、1 mo、2 mo、3 mo角膜内皮细胞密度及六角形内皮细胞百分比均明显低于术前，差异有统计学意义(P < 0.05)。采用非条件Logistic逐步回归分析显示，年龄、浅前房、短眼轴、超声时间长、超声能量高、累积释放能高、大量的灌注液及核硬度与角膜内皮细胞损伤有关，差异均有统计学意义(P < 0.05)。其中核硬度、年龄、超声能量高、超声时间长、累积释放能量是角膜内皮细胞损伤的危险因素(P < 0.01)。结论：白内障患者术后角膜内皮细胞密度及六角形内皮细胞百分比均明显低于术前，超声乳化人工晶体植入术对角膜内皮细胞有损伤。核硬度高、年龄大、超声能量高、超声时间长、累积释放能量是白内障超声乳化人工晶体植入术角膜内皮细胞损伤的主要危险因素。

Abstract: Objective: To investigate the risk factors of corneal endothelial cell injury after phacoemulsification and intraocular lens implantation in cataract patients. Methods: 216 patients (278 eyes) who underwent phacoemulsification cataract extraction and intraocular lens implantation from January 2018 to December 2018 were retrospectively analyzed. The corneal endothelial cell density and percentage of hexagonal cells were observed before and after operation at 1 wk, 1 mo, 2 mo and 3 mo, and the risk factors of corneal endothelial cell injury were analyzed by multiple logistic regression. Results: The corneal endothelial cell density and percentage of hexagonal endothelial cells at 1 wk, 1 mo, 2 mo and 3 mo after operation were significantly lower than those before operation (P < 0.05). The unconditional logistic stepwise regression analysis showed that age, shallow anterior chamber, short eye axis, long ultrasound time, high ultrasound energy, high cumulative release energy, large amount of perfusion fluid and nuclear hardness were related to corneal endothelial cell injury, the difference was statistically significant (P < 0.05). Among them, nuclear hardness, age, high ultrasound energy, long ultrasound time and cumulative release energy were risk factors for corneal endothelial cell injury (P < 0.01). Conclusion: Corneal endothelial cell density and percentage of hexagonal endothelial cells after cataract surgery are significantly lower than those before surgery. Phacoemulsification and intraocular lens implantation can damage corneal endothelial cells. High nuclear hardness, age, high ultrasound energy, long ultrasound time and cumulative release energy are the main risk factors for corneal endothelial cell injury after phacoemulsification and intraocular lens implantation.