超声乳化预劈核技术对PACG合并白内障患者角膜内皮的应用效果
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摘要
目的分析原发性闭角型青光眼(PACG)合并白内障患者应用超声乳化预劈核技术对视力恢复、角膜内皮细胞损伤的影响。方法选取2013年11月～2017年3月来我院就诊的40例PACG合并白内障患者,依照患者治疗意愿分为两组,传统超乳组(19例)和超乳预劈核组(21例)。传统超乳组采用传统超乳手术,超乳预劈核组在传统超乳手术基础上采用预劈核技术,两组术后1、3、7 d开展随访,并于治疗后1个月回院复查。观察比较两组手术前后视力差异、角膜内皮细胞密度、六角形细胞比例。结果两组术前视力、眼压、角膜内皮细胞密度、六角形细胞比例比较,差异无统计学意义(P>0.05)。两组术后1、3 d视力比较,差异无统计学意义(P>0.05);但术后7 d超乳预劈核组最佳视力高于传统超乳组,差异有统计学意义(P<0.05)。两组术后1、3 d眼压数值比较,差异无统计学意义(P>0.05);但术后7 d超乳预劈核组眼压数值低于传统超乳组,差异有统计学意义(P<0.05)。术后1、3 d两组角膜内皮细胞密度比较,差异无统计学意义(P>0.05);术后7 d超乳预劈核组角膜内皮细胞密度高于传统超乳组,差异有统计学意义(P<0.05)。术后1、3 d六角形细胞比例的比较,差异无统计学意义(P>0.05);术后7 d超乳预劈核组六角形细胞比例高于传统超乳组,差异有统计学意义(P<0.05)。超乳预劈核组术后1个月门诊复诊用降眼压药物种类少于传统超乳组,差异有统计学意义(P<0.05)。结论对PACG合并白内障患者行预劈核技术超声乳化晶体摘除联合人工晶体植入术能减轻传统超乳手术对角膜内皮的影响,术后视力恢复快,值得临床推广。
Objective To analyze the effect of phacoemulsification pre-chopping technique on visual acuity and corneal endothelial cell injury in patients with primary angle-closure glaucoma(PACG) and cataract. Methods 40 patients with PACG and cataract who came to our hospital from November 2013 to March 2017 were selected and divided into two groups according to the patients′ wishes of treatment, the traditional super-milk group(19 cases) and the super-milk pre-chopping group(21 cases). Traditional super-milk group was used in the traditional super-breast surgery. The super-breast pre-chopping nucleus group applied pre-chopping technology on the basis of traditional super-breast surgery, followed up the patients of the two groups 1, 3 and 7 day after surgery, and told them to go back to the hospital for review one month after treatment. The visual acuity difference, corneal endothelial cell density and hexagonal cell ratio before and after operation were observed and compared between the two groups. Results There was no significant difference in preoperative vision, intraocular pressure, corneal endothelial cell density and hexagonal cell ratio between the two groups before surgery(P >0.05). There was no statistical difference in visual acuity between the two groups at 1 and 3 d after surgery(P>0.05). However, 7 days after surgery, the best visual acuity of the patients in the pre-chopping group was significantly higher than that in the conventional group, and the difference was statistically significant(P<0.05). There was no statistical difference in intraocular pressure between the two groups at 1 and 3 d after surgery(P>0.05). However, the intraocular pressure of the patients in the pre-chopping group was significantly lower than that in the conventional group 7 days after surgery(P<0.05). There was no statistical difference in corneal endothelial cell density between the two groups 1 and 3 d after surgery(P>0.05). The corneal endothelial cell density in the pre-chopping nucleus group of Zhou Chao milk after surgery was higher than that in the conventional super-emulsion group, the difference was statistically significant(P<0.05). There was no statistical difference in the percentage of hexagonal cells between 1 and 3 d after surgery(P>0.05). The percentage of hexagonal cells in the pre-chopping group was higher than that in the conventional group 7 d after surgery and the difference was statistically significant(P<0.05).There was a statistically significant difference in the types of drugs used to reduce intraocular pressure in the outpatient clinic 1 month after surgery compared with that before surgery(P <0.05). Conclusion Phacoemulsification combined with intraocular lens implantation for patients with PACG complicated with cataract can reduce the influence of traditional phacoemulsification on corneal endothelium, and the postoperative visual acuity can recover quickly, which is worthy of clinical promotion.
Objective To analyze the effect of phacoemulsification pre-chopping technique on visual acuity and corneal endothelial cell injury in patients with primary angle-closure glaucoma(PACG) and cataract. Methods 40 patients with PACG and cataract who came to our hospital from November 2013 to March 2017 were selected and divided into two groups according to the patients′ wishes of treatment, the traditional super-milk group(19 cases) and the super-milk pre-chopping group(21 cases). Traditional super-milk group was used in the traditional super-breast surgery. The super-breast pre-chopping nucleus group applied pre-chopping technology on the basis of traditional super-breast surgery, followed up the patients of the two groups 1, 3 and 7 day after surgery, and told them to go back to the hospital for review one month after treatment. The visual acuity difference, corneal endothelial cell density and hexagonal cell ratio before and after operation were observed and compared between the two groups. Results There was no significant difference in preoperative vision, intraocular pressure, corneal endothelial cell density and hexagonal cell ratio between the two groups before surgery(P >0.05). There was no statistical difference in visual acuity between the two groups at 1 and 3 d after surgery(P>0.05). However, 7 days after surgery, the best visual acuity of the patients in the pre-chopping group was significantly higher than that in the conventional group, and the difference was statistically significant(P<0.05). There was no statistical difference in intraocular pressure between the two groups at 1 and 3 d after surgery(P>0.05). However, the intraocular pressure of the patients in the pre-chopping group was significantly lower than that in the conventional group 7 days after surgery(P<0.05). There was no statistical difference in corneal endothelial cell density between the two groups 1 and 3 d after surgery(P>0.05). The corneal endothelial cell density in the pre-chopping nucleus group of Zhou Chao milk after surgery was higher than that in the conventional super-emulsion group, the difference was statistically significant(P<0.05). There was no statistical difference in the percentage of hexagonal cells between 1 and 3 d after surgery(P>0.05). The percentage of hexagonal cells in the pre-chopping group was higher than that in the conventional group 7 d after surgery and the difference was statistically significant(P<0.05).There was a statistically significant difference in the types of drugs used to reduce intraocular pressure in the outpatient clinic 1 month after surgery compared with that before surgery(P <0.05). Conclusion Phacoemulsification combined with intraocular lens implantation for patients with PACG complicated with cataract can reduce the influence of traditional phacoemulsification on corneal endothelium, and the postoperative visual acuity can recover quickly, which is worthy of clinical promotion.
引文
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[11]刘婕,赵娴,邵丽静,等.白内障超声乳化吸除术后角膜内皮细胞变化的研究[J].国际眼科杂志,2014,14(12):2247-2249.
[12]Ho JW,Afshari NA.Advances in cataract surgery:preserving the corneal endothelium[J].Curr Opin Ophthalmol,2015,26(1):22-27.
[13]戴子娴,张宏,林妙英,等.白内障超声乳化联合人工晶体植入手术后干眼症的临床观察[J].河北医学,2011,17(8):1011-1013.
[14]裴锦云,林羽,杨海燕.超声乳化联合房角分离术治疗闭角型青光眼合并白内障的临床效果分析[J].天津医药,2016,44(7):906-909.
[15]汪涛,颜华.超声乳化联合前房角分离术对伴有白内障的闭角型青光眼角膜内皮细胞的影响[J].国际眼科杂志,2016,16(11):2142-2144.
[16]蔡树泓,张世华,廖润斌.小梁切除联合白内障超声乳化术对PACG合并初发期白内障的疗效[J].热带医学杂志,2017,17(5):669-671.
[2]Cheng JW,Zong Y,Zeng YY,et al.The prevalence of primary angle closure glaucoma in adult Asians:a systematic review and meta-analysis[J].PloS One,2014,9(7):e103222.
[3]Patel HY,Danesh-Meyer HV.Incidence and management of cataract after glaucoma surgery[J].Curr Opin Ophthalmol,2013,24(1):15-20.
[4]中华医学会眼科学分会青光眼学组.我国青光眼临床诊断和治疗描述性术语专家建议(2018年)[J].中华眼科杂志,2018,54(3):164-166.
[5]Bonanno JA.Identity and regulation of ion transport mechanisms in the corneal endothelium[J].Prog Retin Eye Res,2003,22(1):69-94.
[6]Roy O,Leclerc VB,Bourget JM,et al.Understanding the process of corneal endothelial morphological change in Vitro end MT of the corneal endothelium[J].Invest Ophthalmol Vis Sci,2015,56(2):1228-1237.
[7]Bigar F,Witmer R.Corneal endothelial changes in primary acute angle-closure glaucoma[J].Ophthalmology,1982,89(6):596-599.
[8]Gagnon MM,Boisjoly HM,Brunette I,et al.Corneal endothelial cell density in glaucoma[J].Cornea,1997,16(3):314-318.
[9]Sihota R,Lakshmaiah NC,Titiyal JS,et al.Corneal endothelial status in the subtypes of primary angle closure glaucoma[J].Clin Exp Ophthalmol,2003,31(6):492-495.
[10]梁玲玲,袁进,陈家祺,等.角膜内皮细胞高压力损伤机制的实验研究[J].眼科,2011,20(3):155-159.
[11]刘婕,赵娴,邵丽静,等.白内障超声乳化吸除术后角膜内皮细胞变化的研究[J].国际眼科杂志,2014,14(12):2247-2249.
[12]Ho JW,Afshari NA.Advances in cataract surgery:preserving the corneal endothelium[J].Curr Opin Ophthalmol,2015,26(1):22-27.
[13]戴子娴,张宏,林妙英,等.白内障超声乳化联合人工晶体植入手术后干眼症的临床观察[J].河北医学,2011,17(8):1011-1013.
[14]裴锦云,林羽,杨海燕.超声乳化联合房角分离术治疗闭角型青光眼合并白内障的临床效果分析[J].天津医药,2016,44(7):906-909.
[15]汪涛,颜华.超声乳化联合前房角分离术对伴有白内障的闭角型青光眼角膜内皮细胞的影响[J].国际眼科杂志,2016,16(11):2142-2144.
[16]蔡树泓,张世华,廖润斌.小梁切除联合白内障超声乳化术对PACG合并初发期白内障的疗效[J].热带医学杂志,2017,17(5):669-671.