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目的:对穿透性角膜移植术后白内障进行超声乳化吸除术,分析其对角膜移植片内皮细胞的影响因素。方法:单纯穿透性角膜移植术后11眼,未出现排斥反应7眼,排斥反应控制后3个月以上3眼,余1例为排斥反应控制不到2个月。角膜缝线已拆除。术前裸眼视力光感-0.1,术前及术后均检测角膜植片中央内皮细胞计数,晶体核III-IV级。手术方式为超声乳化吸除联合人工晶体植入术,术中平均超声能量14.82±0.47%,流速26ml/min,负压180-200mmHg(U/SPower),200-210mmHg(U/Spulse)。超声时间1.5min-2.5min(1.95±0.47min)。术后常规抗生素及激素眼液点眼。结果:术后最佳矫正视力0.2-0.5,均较术前提高。术后第2天-第3天,角膜植片少许内皮皱褶,术后第4天角膜恢复透明。术前术后角膜移植片中央部位内皮细胞计数分别为:607-1998/mm2(1248.09±408.52/mm2)和601-1899/mm2(1184.36±373.92mm2),术后内皮细胞丢失率为5.11%,与术前比较采用配对t检验得T=3.6418,P=0.0045<0.05,有统计学意义。随访3个月以上,角膜植片保持透明,内皮细胞稳定。未发现大泡样角膜病变。结论:穿透性角膜移植术后白内障,超声乳化术式安全有效。
Objective: To evaluate the effect of phacoemulsification on cataract after penetrating keratoplasty and its influencing factors on corneal endothelial cells. Methods: There were 11 eyes without penetrating keratoplasty, 7 eyes without rejection, 3 eyes with more than 3 months after rejection control, and 1 case with rejection control less than 2 months. Corneal suture has been removed. Preoperative visual acuity -0.1, preoperative and postoperative central corneal endothelial cell count, crystal nucleus III-IV level. The operation mode was phacoemulsification and intraocular lens implantation. The intraoperative average ultrasonic energy was 14.82 ± 0.47%, the flow rate was 26ml / min, the negative pressure was 180-200mmHg (U / SPower) and 200-210mmHg (U / Spulse). Ultrasound time 1.5min-2.5min (1.95 ± 0.47min). Postoperative conventional antibiotics and hormonal eye drops. Results: The best corrected visual acuity after operation was 0.2-0.5, which was higher than that before operation. On day 2 postoperatively, a little corneal endothelial folds were found on the third day after operation, and the cornea returned to the first day after operation. The number of endothelial cells in the central part of the corneal graft after operation was 607-1998 / mm2 (1248.09 ± 408.52 / mm2) and 601-1899 / mm2 (1184.36 ± 373.92mm2) respectively. The rate of endothelial cell loss after operation was 5.11% Compared with the preoperative use of paired t test was T = 3.6418, P = 0.0045 <0.05, with statistical significance. After 3 months of follow-up, corneal graft remained transparent and endothelial cells were stable. No big bubble-like keratopathy was found. Conclusion: Cataract and phacoemulsification after penetrating keratoplasty is safe and effective.