CAJ | 학술논문

目的研究真菌性角膜溃疡治疗性角膜移植术后的晶状体超声乳化术对角膜植片内皮的长期影响.方法回顾性研究2011年4月至2014年11月收治的真菌角膜溃疡治疗性角膜移植术后的白内障行超声乳化术23例(23只眼).男18例,女5例.年龄41 ～ 86岁,平均(60.4±14.3)岁.真菌角膜溃疡治疗性角膜移植手术前已发生白内障者12例,余为术后发生.所有患者于角膜移植术后6 ～ 24个月,平均(10.2±2.3)个月接受超声乳化联合人工晶状体植入术.随访12～24个月,平均(15.2±5.1)个月.观察比较手术前后角膜内皮密度及角膜中央厚度的变化.结果术前角膜内皮细胞密度平均为(2142 ±370)个/mm2,术后2周角膜内皮细胞平均密度为(1905±206)个/mm2,减少约11％,差异无统计学意义.术后l、3、6及12个月角膜内皮密度分别下降约22％、28％、33.6％和40.7％,与术前比较差异有统计学意义.仅4例复诊24个月,角膜内皮细胞密度平均由(1739 ±241)个/mm2下降到(954±117)个/mm2,较手术前下降约46％,差异有统计学意义.术前角膜中央平均厚度为(540±53) μm,术后2周为(573±54) μm,两者比较差异有统计学意义,术后1个月为(563±66) μm,与术前比较差异无统计学意义,以后没有明显变化.4只眼术后6～ 24个月发生角膜内皮失代偿,此4只眼术前角膜内皮细胞密度较低,平均为(1310 ±223)个/mm2,其中3只眼晶状体核硬度Ⅳ级,1只眼Ⅴ级.结论真菌角膜溃疡治疗性角膜移植术后植片角膜内皮细胞易受到手术损伤,晶状体超声乳化术后角膜内皮细胞丧失明显高于正常角膜,特别是晶体核硬的白内障.建议这类特殊类型的白内障进行超声乳化手术者,要求角膜植片有合理的内皮功能储备,晶状体核硬度不宜大于Ⅲ级.
목적 연구진균성각막궤양치료성각막이식술후적정상체초성유화술대각막식편내피적장기영향.방법 회고성연구2011년4월지2014년11월수치적진균각막궤양치료성각막이식술후적백내장행초성유화술23례(23지안).남18례,녀5례.년령41 ～ 86세,평균(60.4±14.3)세.진균각막궤양치료성각막이식수술전이발생백내장자12례,여위술후발생.소유환자우각막이식술후6 ～ 24개월,평균(10.2±2.3)개월접수초성유화연합인공정상체식입술.수방12～24개월,평균(15.2±5.1)개월.관찰비교수술전후각막내피밀도급각막중앙후도적변화.결과 술전각막내피세포밀도평균위(2142 ±370)개/mm2,술후2주각막내피세포평균밀도위(1905±206)개/mm2,감소약11％,차이무통계학의의.술후l、3、6급12개월각막내피밀도분별하강약22％、28％、33.6％화40.7％,여술전비교차이유통계학의의.부4례복진24개월,각막내피세포밀도평균유(1739 ±241)개/mm2하강도(954±117)개/mm2,교수술전하강약46％,차이유통계학의의.술전각막중앙평균후도위(540±53) μm,술후2주위(573±54) μm,량자비교차이유통계학의의,술후1개월위(563±66) μm,여술전비교차이무통계학의의,이후몰유명현변화.4지안술후6～ 24개월발생각막내피실대상,차4지안술전각막내피세포밀도교저,평균위(1310 ±223)개/mm2,기중3지안정상체핵경도Ⅳ급,1지안Ⅴ급.결론 진균각막궤양치료성각막이식술후식편각막내피세포역수도수술손상,정상체초성유화술후각막내피세포상실명현고우정상각막,특별시정체핵경적백내장.건의저류특수류형적백내장진행초성유화수술자,요구각막식편유합리적내피공능저비,정상체핵경도불의대우Ⅲ급.
Objective To evaluate the long-term influence of phacoemulsification on graft endothelial cells after therapeutic keratoplasty for fungal keratitis.Methods The medical records of 23 eyes of 23 patients who had phacoemulsification following initial therapeutic keratoplasty for fungal keratitis between April 2011 and November 2014 were reviewed retrospectively.Eighteen patients were male and 5 patients were female.The average age was (60.4 ± 14.3) years with a range from 41 to 86 years.These included 12 patients who already had cataract before therapeutic keratoplasty and 11 patients who developed cataract after keratoplasty.All patients underwent phacoemulsific ation at (10.2 ± 2.3) months averagely after therapeutic keratoplasty with a range from 6 to 24 months.The follow-up period ranged from 12 months to 24 months with a average of (15.2 ±5.1) months.Endothelial c ell density (ECD) and central corneal thickness (CCT) were measured before and after the operation.Results The mean ECD decreased from (2142 ± 370) cells/mm2 before phacoemulsification to (1905 ± 206) cells/mm2 two weeks after the operation,the percentage of endothelial cell loss was 11％,and there was no statistical significance in difference.The mean ECD decreased by 22％,28％,33.6％ and 40.7％ 1,3,6 and 12 months after the phacoemulsification respectively and the differences in ECD between before and after the phacoemulsification were statistically significant.Only 4 cases were followed up for 24 months,and the endothelial cell density decreased by 46％.The mean CCT was (540 ±53) μm before the operation and (573 ±54) μm two weeks after the operation,and the difference was statistically significant.There was no statistically significant difference in CCT between preoperation and 1 month after the operation.Four eyes developed graft failure 6-24 months after the phacoemulsification with hard nucleus of grade Ⅳ in 3 eyes and grade Ⅴ in 1 eye and mean ECD of (1310 ±223)/mm2 before the operation.Conclusion The endothelia of transplanted corneal grafts are vulnerable to ultrasonic damage,and the endothelial cell loss is much higher than that in normal cornea,especially in patients with hard nuclear cataract.The results suggest that phacoemulsification dealing with this specific cataract requires reasonable functional reserve of graft endothelia and lens nucleus hardness less than grade Ⅲ.