【摘要】：目的探討23 G前段玻璃體切割聯(lián)合白內(nèi)障超聲乳化手術(shù)治療淺前房低角膜內(nèi)皮細(xì)胞密度(endothelial cell density,ECD)白內(nèi)障的療效及安全性。方法根據(jù)患者自愿原則,將2012年1月至2015年12月在鄭州大學(xué)第二附屬醫(yī)院接受手術(shù)治療的30例(34眼)ECD1000 mm-2的淺前房白內(nèi)障患者分為聯(lián)合手術(shù)組和Phaco組。聯(lián)合手術(shù)組16例(19眼),行23 G前段玻璃體切割聯(lián)合白內(nèi)障超聲乳化術(shù);Phaco組14例(15眼),行單純白內(nèi)障超聲乳化術(shù)。術(shù)后1 d、1周及3個(gè)月檢查兩組患者最佳矯正視力、角膜水腫程度,同時(shí)記錄術(shù)前及術(shù)后3個(gè)月ECD,觀察角膜水腫消退時(shí)間、術(shù)中及術(shù)后并發(fā)癥。結(jié)果術(shù)后1 d,聯(lián)合手術(shù)組最佳矯正視力較術(shù)前顯著增高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1周及3個(gè)月,兩組最佳矯正視力均較術(shù)前顯著增高,差異均有統(tǒng)計(jì)學(xué)意義(均為P0.05)。術(shù)后1 d及1周,聯(lián)合手術(shù)組最佳矯正視力均優(yōu)于Phaco組,差異均有統(tǒng)計(jì)學(xué)意義(均為P0.05)。術(shù)后1 d,聯(lián)合手術(shù)組以1級角膜水腫為主,Phaco組以2級角膜水腫為主,兩組角膜水腫程度差異有統(tǒng)計(jì)學(xué)意義(P0.05)。聯(lián)合手術(shù)組角膜水腫平均消退時(shí)間為1.0 d,小于Phaco組的4.0 d,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后3個(gè)月,聯(lián)合手術(shù)組角膜內(nèi)皮細(xì)胞丟失率為(7.86±0.76)%,低于Phaco組的(13.39±0.47)%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論23 G前段玻璃體切割聯(lián)合白內(nèi)障超聲乳化術(shù)安全性好,角膜內(nèi)皮細(xì)胞損傷小,術(shù)后角膜水腫輕,早期視力恢復(fù)快,適用于淺前房低ECD白內(nèi)障患者。
[Abstract]:Objective to evaluate the efficacy and safety of 23 G anterior vitrectomy combined with phacoemulsification in the treatment of low corneal endothelial cell density (endothelial cell density,ECD) cataract in shallow anterior chamber. Methods from January 2012 to December 2015, 30 patients (34 eyes) with shallow anterior chamber cataract with ECD1000 mm-2 received surgical treatment from January 2012 to December 2015 in the second affiliated Hospital of Zhengzhou University were divided into combined operation group and Phaco group. 16 cases (19 eyes) in combined operation group were treated with 23 G anterior vitrectomy combined with phacoemulsification, and 14 cases (15 eyes) in Phaco group were treated with phacoemulsification. The best corrected visual acuity (BCVA) and corneal edema degree were examined 1 week and 3 months after operation. The time of corneal edema regression, intraoperative and postoperative complications were recorded by ECD, before and 3 months after operation. Results on the 1st day after operation, the best corrected visual acuity in the combined operation group was significantly higher than that in the preoperative group (P0.05). At 1 week and 3 months after operation, the best corrected visual acuity (BCVA) in both groups was significantly higher than that before operation (P0.05). The best corrected visual acuity of the combined operation group was better than that of the Phaco group on the 1st day and 1 week after operation, and the difference was statistically significant (P0.05). One day after operation, the corneal edema was mainly grade 1 in the combined operation group and the second grade in the Phaco group. There was significant difference in the degree of corneal edema between the two groups (P0.05). The mean extinction time of corneal edema in the combined operation group was 1.0 days, which was less than that in the Phaco group (P 0.05). The loss rate of corneal endothelial cells in the combined operation group was (7.86 鹵0.76)%, lower than that in the Phaco group (13.39 鹵0.47)%, the difference was statistically significant (P0.05). Conclusion 23 G anterior vitrectomy combined with phacoemulsification is safe, with little corneal endothelial cell damage, slight corneal edema and rapid recovery of early visual acuity. It is suitable for patients with shallow anterior chamber and low ECD cataract.
【作者單位】： 鄭州大學(xué)第二附屬醫(yī)院眼科;
【分類號】：R779.6

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