孙承栋 张玉光 栗映梅 谭越 杨茹

【摘 要】  目的： 讨论低角膜内皮细胞密度白内障患者在施行白内障超声乳化吸除术后的效果，观察超声乳化吸除术对低角膜内皮细胞密度患者的可行性。 方法： 收集2017-2019年就诊于济南市第二人民医院术前角膜内皮细胞密度在491-1561个/mm 2行白内障超声乳化吸除术+人工晶状体植入术的患者45例（52眼），分析其术后视力、角膜内皮细胞密度及术后并发症。 结果： 多数患眼术后视力有显著改善。术后一周最佳矫正视力≥4.5者36眼占69.3%，≥4.7者25眼占48.1%。术后一月最佳矫正视力≥4.5者39眼占75.01%，≥4.7者34眼占65.4%。术后三月最佳矫正视力≥4.5者39眼占75.01%，≥4.7者34眼占65.4%。3例术后角膜内皮功能失代偿（ 1例术前为Fuchs角膜内皮营养不良患者，1例术前为角膜移植术后患者，1例术前为原发性进行性虹膜萎缩患者）。术后一周、一月、三月角膜内皮细胞损失率分别为3.4%-47.0%、3.7%-48.2%、3.0%-48.8%。 结论： 超声乳化吸除术+人工晶状体植入术能够作为低角膜内皮细胞密度白内障患者的手术选择。

【关键词】  白内障;超声乳化吸除术;角膜内皮细胞;低密度

【中图分类号】  R776.1      【文献标志码】B   【文章编号】1005-0019（2020）05-295-02

Abstract：

Objective： To discuss the effect of phacoemulsification in patients with low corneal endothelial cell density after cataract phacoemulsification， and to observe the feasibility of phacoemulsification in patients with low corneal endothelial cell density.  Methods： A total of 45 patients （52 eyes） who underwent cataract phacoemulsification and intraocular lens implantation at a preoperative corneal endothelial cell density of 491-1561 / mm2 during the 2017-2019 visit to the Second People's Hospital of Jinan were analyzed His postoperative vision， corneal endothelial cell density and postoperative complications.  Results： The visual acuity of most affected eyes improved significantly. One week after the operation， the best corrected visual acuity was ≥4.5 in 36 eyes and 68.1% in ≥4.7 eyes. One month after surgery， the best corrected visual acuity was ≥4.5 in 39 eyes， accounting for 75.01%， and 34 eyes in ≥4.7 accounting for 65.4%. The best corrected visual acuity for three months after surgery was 75.01% in 39 eyes and 65.4% in 34 eyes. Corneal endothelial dysfunction was decompensated in 3 cases （1 patient with Fuchs corneal endothelial dystrophy before surgery， 1 patient with corneal transplant before surgery， and 1 patient with primary progressive iris atrophy before surgery）. The corneal endothelial cell loss rates were 3.4%-47.0%， 3.7%-48.2%， 3.0%-48.8% after one week， one month and three months after the operation.  Conclusion： Phacoemulsification and intraocular lens implantation can be used as a surgical option for patients with low corneal endothelial cell density cataract.

Key words： cataract，phacoemulsification，corneal endothelial cells，low density

白内障（Cataract）是老年患者中最常见的致盲性眼病，据文献统计全世界约有50%的眼盲是由白内障所引起的。随着生活方式的改变，白内障患者群体也逐渐趋于年輕化，随着与白内障发病相关的高度近视、糖尿病等疾病的发病率越来越高，各种并发性白内障和代谢性白内障的患者也越来越常见。白内障超声乳化吸除术（以下简称超乳手术）是综合经济效益及实用效益最佳的手术方式。……