本文選題：晶狀體 + 角膜內(nèi)皮細(xì)胞�。� 參考：《重慶醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:觀察玻璃體切割聯(lián)合硅油填充術(shù)(vitreoretinal surgery and silicone tamponade, VRS)與玻璃體切割+晶狀體切割聯(lián)合硅油填充術(shù)(1enticular vitreoretinal surgery and silicone tamponade, LVRS)后短期內(nèi)角膜內(nèi)皮細(xì)胞的形態(tài)和參數(shù)變化,了解晶狀體對(duì)角膜內(nèi)皮細(xì)胞的保護(hù)作用。 方法:對(duì)32例患者(32只眼)行玻璃體切割聯(lián)合硅油填充術(shù)及玻璃體切割+晶狀體切割聯(lián)合硅油填充術(shù)。應(yīng)用Topcon SP-3000型非接觸型角膜內(nèi)皮顯微鏡測(cè)定術(shù)前和術(shù)后2周內(nèi)角膜內(nèi)皮細(xì)胞,直接觀察角膜內(nèi)皮細(xì)胞的形態(tài)變化,并結(jié)合IMAGEnet系統(tǒng)對(duì)角膜內(nèi)皮4項(xiàng)形態(tài)學(xué)定量指標(biāo)(角膜內(nèi)皮細(xì)胞密度、平均細(xì)胞面積、細(xì)胞面積變異系數(shù)、六角形細(xì)胞百分比)進(jìn)行測(cè)量,對(duì)兩種手術(shù)方式的測(cè)量參數(shù)進(jìn)行統(tǒng)計(jì)學(xué)分析。全部數(shù)據(jù)均采用社會(huì)科學(xué)統(tǒng)計(jì)軟件包(SPSS)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果:玻璃體切割術(shù)后患眼存在細(xì)胞大小一致性改變、細(xì)胞形態(tài)一致性改變、細(xì)胞邊界模糊、細(xì)胞間有黑區(qū)出現(xiàn)及其它異常結(jié)構(gòu)等角膜內(nèi)皮異常形態(tài),以上變化在術(shù)后無晶狀體眼更明顯。對(duì)比術(shù)前、術(shù)后角膜內(nèi)皮細(xì)胞參數(shù)變化,玻璃體切割聯(lián)合硅油填充組術(shù)后角膜內(nèi)皮細(xì)胞密度和六角形細(xì)胞百分比下降、平均細(xì)胞面積和細(xì)胞面積變異系數(shù)增大,但與術(shù)前相比差異無顯著性(P0.05)。玻璃體切割+晶狀體切割聯(lián)合硅油填充組術(shù)后角膜內(nèi)皮細(xì)胞密度和六角形細(xì)胞百分比明顯下降、平均細(xì)胞面積和細(xì)胞面積變異系數(shù)明顯增大,與術(shù)前相比差異有顯著性(P0.05)。 結(jié)論: 1.晶狀體在玻璃體切割術(shù)中通過對(duì)多種損傷因素的屏障作用而對(duì)角膜內(nèi)皮細(xì)胞起到重要的保護(hù)作用,保留晶狀體可最大程度減少各種因素對(duì)角膜內(nèi)皮細(xì)胞的損害。 2.非接觸式角膜內(nèi)皮顯微鏡檢查聯(lián)合IMAGEnet系統(tǒng)對(duì)角膜內(nèi)皮細(xì)胞的定性和定量分析對(duì)于玻璃體切割手術(shù)安全性判斷及并發(fā)癥的術(shù)前評(píng)估具有實(shí)際臨床意義,應(yīng)作為其常規(guī)檢查。 3.為減少角膜內(nèi)皮細(xì)胞的損傷及觀察并發(fā)癥的發(fā)生,臨床醫(yī)生在行玻璃體切割手術(shù)時(shí),應(yīng)當(dāng)重視對(duì)角膜內(nèi)皮細(xì)胞的檢查和保護(hù)。 4.術(shù)前檢查發(fā)現(xiàn)角膜內(nèi)皮細(xì)胞功能欠佳的患者,盡量選擇保留晶狀體的玻璃體切割術(shù)。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R779.6

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