【摘要】：目的研究三種不同白內(nèi)障超聲乳手術(shù)切口:上方鞏膜隧道切口、右上方透明角膜切口、顳側(cè)透明角膜切口聯(lián)合人工晶體植入術(shù)后角膜內(nèi)皮細胞、角膜散光的變化情況,及分析引起角膜內(nèi)皮細胞變化的有關(guān)因素。 方法對90例白內(nèi)障患者(132只眼)隨機分為三組:A組:上方鞏膜隧道切口(30人,45只眼)、B組:右上方透明角膜切口(29人,41只眼)、C組:顳側(cè)透明角膜切口(31人,46只眼),行超聲乳化聯(lián)合人工晶體植入術(shù),術(shù)前評價患者術(shù)眼裸眼視力、晶體核硬度、測量前房深度(anterior chamber depth ACD)、角膜中央內(nèi)皮細胞密度、角膜散光度,術(shù)中記錄超乳時間(ultrasound time UST)、累積釋放能量(cumulative dissipated energy CDE),分別于術(shù)后1周、1個月、3個月測量裸眼視力、角膜中央內(nèi)皮細胞密度及角膜散光度,觀察散光軸向,計算角膜內(nèi)皮細胞丟失率,進行統(tǒng)計學(xué)分析。 結(jié)果 (1)A、B及C三組間術(shù)前及術(shù)后1w、1mo、3mo角膜內(nèi)皮細胞密度差異均無統(tǒng)計學(xué)意義(P0.05)。 (2)A組術(shù)前與術(shù)后,及術(shù)后三次角膜內(nèi)皮細胞密度差異無統(tǒng)計學(xué)意義(P0.05)。 (3)B組、C組術(shù)前與術(shù)后1w、1mo、3mo間角膜內(nèi)皮細胞密度差異有統(tǒng)計學(xué)意義(P0.05),術(shù)后1w與1mo、術(shù)后1w與3mo、術(shù)后1mo與3mo間差異無統(tǒng)計學(xué)意義。(P0.05)。 (4)晶體核硬度與角膜內(nèi)皮細胞損傷具有正相關(guān)性(P0.05)。 (5)A組、B組術(shù)后逆規(guī)性散光比例有不同程度的增加,C組逆規(guī)性散光比例有下降的趨勢。 (6)A與B組,B組與C組間術(shù)后1w、1mo、3mo角膜散光度差異有統(tǒng)計學(xué)意義(P0.05)。A與C組間術(shù)后1w、1mo、3mo角膜散光度差異無統(tǒng)計學(xué)意義(P0.05)。 (7) B組術(shù)前與術(shù)后1w、1mo、3mo三組角膜散光度差異有統(tǒng)計學(xué)意義(P0.05),術(shù)后1w與1mo、術(shù)后1w與3mo、術(shù)后1mo與3mo間差異無統(tǒng)計學(xué)意義。 (8)A組、C組術(shù)前與術(shù)后及術(shù)后三次角膜散光度差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論:顳側(cè)透明切口與鞏膜隧道切口引起的角膜內(nèi)皮細胞損傷僅是術(shù)后早期的反應(yīng),引起角膜內(nèi)皮細胞損傷的主要因素是晶體的核硬度。兩種切口均不會引起術(shù)后高散光。右上方透明角膜切口操作方便,但角膜內(nèi)皮細胞損傷及引起散光較其它兩種明顯。
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.66

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