Fuchs角膜内皮营养不良合并高度近视患者的白内障手术疗效观察

发布时间：2018-10-09 12:58

【摘要】：目的·观察Fuchs角膜内皮营养不良(FECD)合并高度近视患者行白内障超声乳化吸除联合人工晶状体(IOL)植入术的手术效果与安全性。方法·回顾性对2015年1月至2016年2月在上海交通大学医学院附属新华医院眼科通过角膜共聚焦显微镜检查确诊为FECD,且合并高度近视及白内障的5例患者(9眼)进行研究。患者均行白内障超声乳化吸除联合IOL植入术。观察手术前后视力、眼压、角膜内皮细胞密度(CD)、中央角膜厚度(CCT)的变化等情况。采用配对t检验行统计学分析。结果·9眼中有8眼术后最佳矫正视力至少提高2行,有4眼达到0.6以上。手术前后眼压比较差异无统计学意义(t=-1.066,P=0.318)。手术前后CD分别为(2 184.25±196.44)个/mm~2和(1 910.0±83.41)个/mm~2,差异无统计学意义(t=2.876,P=0.064)。角膜内皮细胞丢失率为(12.10±7.84)%。手术前后CCT分别为(546.83±33.74)μm和(566.67±24.66)μm,差异无统计学意义(t=1.971,P=0.106)。有1眼术前术后CD测不出,术后视力无改善,且角膜基质混浊水肿明显,后行穿透性角膜移植术。结论·FECD合并高度近视患者行白内障超声乳化吸除联合IOL植入术是安全、有效的。术前需准确评估角膜内皮状况和预后,术中采取必要措施尽量减少内皮细胞损伤以保证疗效。
[Abstract]:Objective to observe the effect and safety of phacoemulsification combined with intraocular lens (IOL) implantation in patients with Fuchs corneal endothelial dystrophy (FECD) and high myopia. Methods from January 2015 to February 2016, 9 eyes of 5 patients (9 eyes) with high myopia and cataract diagnosed by confocal corneal microscopy at Xinhua Hospital affiliated to School of Medicine of Shanghai Jiaotong University were studied retrospectively. All patients were treated with phacoemulsification combined with IOL implantation. Visual acuity intraocular pressure (IOP) and corneal endothelial cell density (CD),) central corneal thickness (CCT) were observed before and after operation. The paired t test was used for statistical analysis. Results in 9 eyes, the best corrected visual acuity (BCVA) improved by at least 2 lines in 8 eyes, and reached 0.6 in 4 eyes. There was no significant difference in intraocular pressure before and after operation (t0. 066 P 0. 318). The CD before and after operation were (2 184.25 卤196.44) / mm2 and (1 910.0 卤83.41) / mm2, respectively. There was no significant difference between them (t = 2.876). The loss rate of corneal endothelial cells was (12.10 卤7.84). The CCT before and after operation were (546.83 卤33.74) 渭 m and (566.67 卤24.66) 渭 m, respectively. In 1 eye, CD was not measured before and after operation, visual acuity was not improved, corneal stroma edema was obvious, and penetrating keratoplasty was performed. Conclusion phacoemulsification combined with IOL implantation in FECD with high myopia is safe and effective. The corneal endothelial condition and prognosis should be evaluated accurately before operation, and the necessary measures should be taken to minimize the injury of endothelial cells in order to ensure the curative effect.
【作者单位】：上海交通大学医学院附属新华医院眼科;
【分类号】：R779.66

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