晶状体在玻璃体切割手术中对角膜内皮细胞的保护作用的短期观察

发布时间：2018-06-16 19:21

本文选题：晶状体 + 角膜内皮细胞　；参考：《重庆医科大学》2011年硕士论文

【摘要】：目的:观察玻璃体切割联合硅油填充术(vitreoretinal surgery and silicone tamponade, VRS)与玻璃体切割+晶状体切割联合硅油填充术(1enticular vitreoretinal surgery and silicone tamponade, LVRS)后短期内角膜内皮细胞的形态和参数变化,了解晶状体对角膜内皮细胞的保护作用。方法:对32例患者(32只眼)行玻璃体切割联合硅油填充术及玻璃体切割+晶状体切割联合硅油填充术。应用Topcon SP-3000型非接触型角膜内皮显微镜测定术前和术后2周内角膜内皮细胞,直接观察角膜内皮细胞的形态变化,并结合IMAGEnet系统对角膜内皮4项形态学定量指标(角膜内皮细胞密度、平均细胞面积、细胞面积变异系数、六角形细胞百分比)进行测量,对两种手术方式的测量参数进行统计学分析。全部数据均采用社会科学统计软件包(SPSS)进行统计学分析。结果:玻璃体切割术后患眼存在细胞大小一致性改变、细胞形态一致性改变、细胞边界模糊、细胞间有黑区出现及其它异常结构等角膜内皮异常形态,以上变化在术后无晶状体眼更明显。对比术前、术后角膜内皮细胞参数变化,玻璃体切割联合硅油填充组术后角膜内皮细胞密度和六角形细胞百分比下降、平均细胞面积和细胞面积变异系数增大,但与术前相比差异无显著性(P0.05)。玻璃体切割+晶状体切割联合硅油填充组术后角膜内皮细胞密度和六角形细胞百分比明显下降、平均细胞面积和细胞面积变异系数明显增大,与术前相比差异有显著性(P0.05)。结论: 1.晶状体在玻璃体切割术中通过对多种损伤因素的屏障作用而对角膜内皮细胞起到重要的保护作用,保留晶状体可最大程度减少各种因素对角膜内皮细胞的损害。 2.非接触式角膜内皮显微镜检查联合IMAGEnet系统对角膜内皮细胞的定性和定量分析对于玻璃体切割手术安全性判断及并发症的术前评估具有实际临床意义,应作为其常规检查。 3.为减少角膜内皮细胞的损伤及观察并发症的发生,临床医生在行玻璃体切割手术时,应当重视对角膜内皮细胞的检查和保护。 4.术前检查发现角膜内皮细胞功能欠佳的患者,尽量选择保留晶状体的玻璃体切割术。
[Abstract]:Objective: to observe the changes of morphology and parameters of corneal endothelial cells after vitreoretinal surgery and silicone tamponade, (vitreoretinal surgery and silicone tamponade,) and vitreoretinal surgery and silicone tamponade, (vitreoretinal surgery and silicone tamponade,) and vitrectomy combined with silicone oil filling (VRS). To investigate the protective effect of lens on corneal endothelial cells. Methods: vitrectomy combined with silicone oil implantation and vitrectomy combined with silicone oil filling were performed in 32 eyes of 32 patients. The corneal endothelial cells were measured by Topcon SP-3000 non-contact corneal endothelial microscope before and 2 weeks after operation, and the morphological changes of corneal endothelial cells were observed directly. The corneal endothelial cell density, mean cell area, coefficient of variation of cell area, percentage of hexagonal cells were measured with IMAGEnet system. The measurement parameters of two kinds of surgical methods were analyzed statistically. All the data were analyzed by SPSS. Results: after vitrectomy, there were changes of cell size consistency, cell morphology consistency, blur of cell boundary, appearance of black area between cells and other abnormal structure of corneal endothelium. These changes were more obvious in aphakic eyes after operation. Compared with the preoperative and postoperative changes of corneal endothelial cell parameters, the corneal endothelial cell density and the percentage of hexagonal cells decreased, and the mean cell area and the coefficient of variation of cell area increased in vitrectomy combined with silicone oil filling group. But there was no significant difference between before and after operation (P 0.05). The corneal endothelial cell density and the percentage of hexagonal cells in the vitrectomy combined with silicone oil implantation group decreased significantly, and the average cell area and cell area variation coefficient increased significantly compared with those before the operation (P 0.05). Conclusion: 1. During vitrectomy, lens plays an important role in protecting corneal endothelial cells by acting as a barrier to many kinds of injury factors, and preserving lens can minimize the damage of various factors to corneal endothelial cells. 2. Non-contact corneal endothelial microscopy combined with IMAGEnet system for the qualitative and quantitative analysis of corneal endothelial cells has practical clinical significance in judging the safety of vitrectomy and evaluating the complications before vitrectomy. Shall be as its regular examination. 3. In order to reduce the injury of corneal endothelial cells and observe the occurrence of complications, clinicians should pay attention to the examination and protection of corneal endothelial cells during vitrectomy. 4. Preoperative examination found that the corneal endothelial function of patients, as far as possible to choose the lens-preserving vitrectomy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

【参考文献】