急性闭角型青光眼超声乳化术后角膜内皮细胞的损伤及相关影响因素的研究

发布时间：2018-05-06 13:23

本文选题：青光眼 + 闭角型　；参考：《青岛大学》2011年硕士论文

【摘要】：目的观察急性闭角型青光眼急性发作期患眼行晶状体超声乳化联合后房型人工晶状体植入术后角膜内皮的变化,并探讨引起其变化的相关因素,以期了解此手术方式对急性闭角型青光眼急性发作眼角膜内皮细胞的损伤及影响因素。方法收集于2009年3月至2010年6月因急性闭角型青光眼(acute angle-closure glaucoma, AACG)急性发作期收入院并行超声乳化手术治疗的患眼的临床资料。完成常规随诊后嘱患者于术后3m、6m、12m时随诊,检查患者视力、眼压及角膜内皮细胞情况。比较AACG患者患眼角膜内皮细胞与对侧眼角膜内皮细胞之间的差异并分析相关影响因素。比较AACG患者患眼术前术后角膜内皮细胞的变化,并计算各随访期角膜内皮细胞丢失率,分析术后角膜内皮细胞丢失率的相关影响因素。结果58例(63眼)AACG患者完成随访。术后随访12m。AACG急性发作期眼角膜内皮细胞显著下降(F=18.51,P=0.000),角膜内皮细胞丢失率为14.1%。高眼压持续时间长组角膜内皮细胞丢失率高于高眼压持续时间短组(F=6.593,P=0.016)；前房穿刺组角膜内皮细胞较药物组角膜内皮细胞下降,差异无统计学意义(F=0.145,P=0.705)。术后角膜内皮细胞密度较术前显著下降(P值均为0.000),术后3m、6m、12m角膜内皮细胞下降率分别为23.5%、31.51%、31.92%。与术前相比,术后3m时六角形细胞百分数显著减少(P=0.042),平均细胞面积显著增大(P=0.047).角膜内皮细胞下降率与眼轴长度、前房深度均呈负相关(r=-0.293,P=0.014；r=-0.312,P=0.01)。角膜内皮细胞下降率与晶状体厚度、超声乳化时间、超声乳化能量均呈正相关(r=0.329,P=0.007；r=0.427,P=0.001；r=0.396,P=0.003)。前房深度与眼轴长度呈正相关(r=0.336,P=0.006),与晶状体厚度呈负相关(r=-0.387,P=0.002)。结论本研究观察了AACG超声乳化术后角膜内皮细胞的损伤及相关影响因素的研究。发现AACG急性大发作后角膜内皮细胞明显下降,丢失率为14.1%,其与高眼压持续时间有关,与前房穿刺放液无关。行超声乳化术后3m、6m、12m角膜内皮细胞丢失率分别为23.5%、31.51%、31.92%,差异无显著性。术后角膜内皮细胞丢失率与眼轴长度、前房深度呈负相关,与晶状体厚度、超声乳化时间及超声乳化能量呈正相关。
[Abstract]:Objective to observe the changes of corneal endothelium after phacoemulsification combined with posterior chamber intraocular lens implantation in patients with acute angle-closure glaucoma (ACG) and to explore the related factors. Objective to investigate the injury of corneal endothelial cells in acute angle-closure glaucoma (ACG) and its influencing factors. Methods from March 2009 to June 2010, the clinical data of patients with acute angle-closure glaucoma were collected and treated by phacoemulsification. After the routine follow-up was completed, the patients were asked to follow up at 3mto 6mand 12m after operation to examine the visual acuity, intraocular pressure and corneal endothelial cells. To compare the difference between corneal endothelial cells and contralateral corneal endothelial cells in AACG patients and analyze the related factors. To compare the changes of corneal endothelial cells before and after operation in patients with AACG, to calculate the rate of corneal endothelial cell loss in each follow-up period, and to analyze the related factors of corneal endothelial cell loss rate after operation. Results 58 patients (63 eyes) with AACG were followed up. The corneal endothelial cells decreased significantly during the acute attack of 12m.AACG and the loss rate of corneal endothelial cells was 14.1%. The loss rate of corneal endothelial cells in the group of long duration of high intraocular pressure was higher than that in the group of short duration of high intraocular pressure, and the corneal endothelial cells in the anterior chamber puncture group were lower than those in the drug group, and there was no significant difference between the two groups. The corneal endothelial cell density decreased significantly after operation (P = 0.000), and the decrease rate of corneal endothelial cells was 33.5% and 31.92%, respectively. Compared with those before operation, the percentage of hexagonal cells decreased significantly at 3 m after operation, and the average cell area increased significantly. The decrease rate of corneal endothelial cells was negatively correlated with the length of eye axis and the depth of anterior chamber. The decrease rate of corneal endothelial cells was positively correlated with lens thickness, phacoemulsification time and phacoemulsification energy. There was a positive correlation between anterior chamber depth and axial length of the eye, and a negative correlation between anterior chamber depth and lens thickness. Conclusion the injury of corneal endothelial cells after AACG phacoemulsification and the related factors were observed. It was found that the corneal endothelial cells decreased significantly after acute attack of AACG, and the loss rate was 14.1%, which was related to the duration of high intraocular pressure, but not to anterior chamber puncture. After phacoemulsification, the loss rate of corneal endothelial cells was 23.5and 31.51and 31.92, respectively. There was no significant difference between the two groups. The rate of corneal endothelial cell loss was negatively correlated with eye axis length and anterior chamber depth, and positively correlated with lens thickness, phacoemulsification time and phacoemulsification energy.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.66

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