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三种白内障超声乳化手术切口术后角膜内皮细胞及角膜散光变化分析

发布时间:2018-10-07 19:35
【摘要】:目的研究三种不同白内障超声乳手术切口:上方巩膜隧道切口、右上方透明角膜切口、颞侧透明角膜切口联合人工晶体植入术后角膜内皮细胞、角膜散光的变化情况,及分析引起角膜内皮细胞变化的有关因素。 方法对90例白内障患者(132只眼)随机分为三组:A组:上方巩膜隧道切口(30人,45只眼)、B组:右上方透明角膜切口(29人,41只眼)、C组:颞侧透明角膜切口(31人,46只眼),行超声乳化联合人工晶体植入术,术前评价患者术眼裸眼视力、晶体核硬度、测量前房深度(anterior chamber depth ACD)、角膜中央内皮细胞密度、角膜散光度,术中记录超乳时间(ultrasound time UST)、累积释放能量(cumulative dissipated energy CDE),分别于术后1周、1个月、3个月测量裸眼视力、角膜中央内皮细胞密度及角膜散光度,观察散光轴向,计算角膜内皮细胞丢失率,进行统计学分析。 结果 (1)A、B及C三组间术前及术后1w、1mo、3mo角膜内皮细胞密度差异均无统计学意义(P0.05)。 (2)A组术前与术后,及术后三次角膜内皮细胞密度差异无统计学意义(P0.05)。 (3)B组、C组术前与术后1w、1mo、3mo间角膜内皮细胞密度差异有统计学意义(P0.05),术后1w与1mo、术后1w与3mo、术后1mo与3mo间差异无统计学意义。(P0.05)。 (4)晶体核硬度与角膜内皮细胞损伤具有正相关性(P0.05)。 (5)A组、B组术后逆规性散光比例有不同程度的增加,C组逆规性散光比例有下降的趋势。 (6)A与B组,B组与C组间术后1w、1mo、3mo角膜散光度差异有统计学意义(P0.05)。A与C组间术后1w、1mo、3mo角膜散光度差异无统计学意义(P0.05)。 (7) B组术前与术后1w、1mo、3mo三组角膜散光度差异有统计学意义(P0.05),术后1w与1mo、术后1w与3mo、术后1mo与3mo间差异无统计学意义。 (8)A组、C组术前与术后及术后三次角膜散光度差异无统计学意义(P0.05)。 结论:颞侧透明切口与巩膜隧道切口引起的角膜内皮细胞损伤仅是术后早期的反应,引起角膜内皮细胞损伤的主要因素是晶体的核硬度。两种切口均不会引起术后高散光。右上方透明角膜切口操作方便,但角膜内皮细胞损伤及引起散光较其它两种明显。
[Abstract]:Objective to study the changes of corneal endothelium and corneal astigmatism in three kinds of phacoemulsification incision: superior scleral tunnel incision, right superior transparent corneal incision and temporal transparent corneal incision combined with intraocular lens implantation. And analyze the related factors that cause the change of corneal endothelial cells. Methods 90 cataract patients (132 eyes) were randomly divided into three groups: group A: upper scleral tunnel incision (30 eyes, 45 eyes), group B, right superior transparent corneal incision (29 eyes, 41 eyes), group C, temporal clear corneal incision (31 eyes, 46 eyes). Phacoemulsification combined with intraocular lens implantation, The visual acuity, the hardness of lens nucleus, the density of central endothelial cells and the astigmatism of (anterior chamber depth ACD), cornea were evaluated before operation. Intraoperative recording of superemulsion time (ultrasound time UST), cumulative release energy (cumulative dissipated energy CDE), was performed at 1 week, 1 month and 3 months after operation. The visual acuity, corneal central endothelial cell density and corneal astigmatism were measured. The axial direction of astigmatism was observed and the loss rate of corneal endothelial cells was calculated. Statistical analysis was carried out. Results (1) there was no significant difference in corneal endothelial cell density between group A B and group C before and 1 week after operation (P0.05). (2) there was no significant difference in corneal endothelial cell density between group A before and after operation and three times after operation (P0.05). (3) the density of corneal endothelial cells in group B was significantly different from that in group C before operation and 1 month after operation (P0.05), but there was no significant difference between group B and group C at 1 week and 1 week after operation, and between 1mo and 3mo at 1 week after operation (P0.05). (4) the hardness of crystal nucleus was positively correlated with corneal endothelial cell injury (P0.05). (5) the proportion of inverse astigmatism in group A and group B increased in varying degrees after operation, and the proportion of inverse astigmatism in group C decreased. (6) there was significant difference in corneal astigmatism between group A and group B (P 0.05). There was no significant difference in corneal astigmatism between group A and group C (P 0.05). (7) the corneal astigmatism in group B was significantly different from that in group B 1 week after operation and 1 month after operation (P0.05), but there was no significant difference between 1mo and 3mo at 1 week after operation and 1 week after operation. (8) there was no significant difference in corneal astigmatism between group A and C before and after operation (P0.05). Conclusion: the injury of corneal endothelial cells caused by temporal clear incision and scleral tunnel incision is only an early postoperative reaction. The main factor causing corneal endothelial cell injury is the hardness of crystal nucleus. Neither incision causes postoperative high astigmatism. Transparent corneal incision in the upper right is easy to operate, but corneal endothelial cell injury and astigmatism are more obvious than the other two.
【学位授予单位】:安徽医科大学
【学位级别】:硕士
【学位授予年份】:2011
【分类号】:R779.66

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