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中华眼科医学杂志(电子版) ›› 2020, Vol. 10 ›› Issue (06) : 357 -362. doi: 10.3877/cma.j.issn.2095-2007.2020.06.007

论著

两种黏弹剂及超声乳化时间对超声乳化白内障吸除联合人工晶状体植入术患者角膜内皮细胞及角膜厚度影响的临床研究
张红言1, 孙璐2, 宋旭东1, 宋红欣1,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　北京市眼科学与视觉科学重点实验室
    2. 100730　首都医科大学附属北京同仁医院2019级博士研究生
  • 收稿日期:2020-11-09 出版日期:2020-12-28
  • 通信作者: 宋红欣
  • 基金资助:
    首都卫生科研发展专项基金项目(2018-2z-1082)

Effects of two kinds of viscoelastics and phacoemulsification time on corneal endothelial cells and corneal thickness in phacoemulsification combined with intraocular lens implantation

Hongyan Zhang1, Lu Sun2, Xudong Song1, Hongxin Song1,†()   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
    2. Doctor′s degree 2019, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2020-11-09 Published:2020-12-28
  • Corresponding author: Hongxin Song
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张红言, 孙璐, 宋旭东, 宋红欣. 两种黏弹剂及超声乳化时间对超声乳化白内障吸除联合人工晶状体植入术患者角膜内皮细胞及角膜厚度影响的临床研究[J]. 中华眼科医学杂志(电子版), 2020, 10(06): 357-362.

Hongyan Zhang, Lu Sun, Xudong Song, Hongxin Song. Effects of two kinds of viscoelastics and phacoemulsification time on corneal endothelial cells and corneal thickness in phacoemulsification combined with intraocular lens implantation[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2020, 10(06): 357-362.

目的

探讨两种黏弹剂及超声乳化时间对超声乳化白内障吸除联合人工晶状体植入术患者角膜内皮细胞及角膜厚度的影响。

方法

纳入2016年7月至2018年1月就诊于首都医科大学附属北京同仁医院眼科中心的白内障患者158例(235只眼)进行研究。其中，男性71例(112只眼)，女性87例(123只眼)；年龄31~90岁，平均年龄(66.7±2.3)岁。根据使用黏弹剂类型不同，将全部患者分为DisCoVisc黏弹剂(OVD1)组和爱维黏弹剂(OVD2)组。均采用做角膜透明主切口后及人工晶状体植入前注入黏弹剂。检查并记录全部患者术前及术后一个月的角膜内皮细胞密度(CECD)和角膜中央厚度(CCT)；记录全部患者手术中超声乳化时间，并对术中超声乳化时间超过5 s者进行标记。患者CECD及CCT符合正态分布，以均数±标准差描述，采用独立样本t检验进行组间比较。两组CECD与手术持续时间的相关性，使用Person相关系数进行评价。

结果

术前OVD1组和OVD2组患者的CECD分别为(2582±344)个细胞/mm2和(2578±322)个细胞/mm2 ；术后一个月OVD1组和OVD2组患者的CECD分别为(2241±547)个细胞/mm2和(2152±580)个细胞/mm2。经t检验，两组间差异均无统计学意义(t＝-0.07，0.16 ；P>0.05)。其中，术中超声乳化时间超过5 s的患者，术前OVD1组和OVD2组患者的CECD分别为(2491±370)个细胞/mm2和(2566±329)个细胞/mm2 ；术后一个月OVD1组和OVD2组患者的CECD分别为(2123±532)个细胞/mm2和(1933±572)个细胞/mm2 。OVD2组患者角膜内皮细胞损失明显高于OVD1组，二者差异有统计学意义(t＝-2.69 ，P<0.05)。术前OVD1组和OVD 2组患者的CCT分别为(518.6±32.7) μm和(514.0±29.1) μm；术后一个月OVD1组和OVD2组患者的CCT分别为(533.1±36.7) μm和(526.7±36.8) μm。经t检验，术前与术后一个月两组患者的CCT变化差异均无统计学意义(t＝-1.01，-1.15 ；P>0.05)。其中，术中超声乳化时间超过5 s的患者，术前OVD1组和OVD2组患者的CCT分别为(519.3±37.6)μm和(516.3±30.8)μm；术后一个月OVD1组和OVD2组患者的分别为(537.3±40.8)μm和(531.5±39.2)μm。经t检验，两组患者CCT之间的差异均无统计学意义(t＝-1.03, -0.09；P>0.05)。OVD1组和OVD2组患者的CECD与术中超声乳化时间的相关性，采用Pearson相关系数进行评价呈正相关，经检验差异有统计学意义(r＝0.48，0.36；P<0.05)。

结论

与爱维黏弹剂相比，DisCoVisc黏弹剂有更好的黏着性和弥散性，同时在白内障手术使用更大的超乳能量时，能够更好的保护角膜内皮细胞。

关键词: 角膜内皮细胞, 黏弹剂, 白内障超声乳化术
Objective

To compare the performance of protection of corneal endothelial cells and corneal thickness in phacoemulsification combined with intraocular lens implantation using two different ophthalmic viscosurgical devices (OVD).

Methods

A total of 158 cataract patients (234 eyes) admitted to the Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from July 2016 to January 2018 were included in this study. Among of them, there were 71 males (112 eyes) and 87 females (123 eyes). The average age was (66.7±2.3) years-old. The patients were randomly divided into two groups according to the usage of different OVDs. DisCoVisc (OVD1) group and IVIZ (OVD2) group. All patients were used standard self-sealing clear corneal incisions, capsulorhexis, and phacoemulsification. Corneal endothelial cell density(CECD) and central corneal thickness (CCT) were examined and recorded before the surgery and after the surgery for one month. The duration of operation and duration of intraoperative phacoemulsification were recorded for all patients, phacoemulsification exceeded 5 s were separately recorded. Because CEDE and CCT were normally distributed, all data were described by (±s) and were tested using independent t test for group comparison. The Person correlation coefficient was used to evaluate the correlation analysis CECD between them.

Results

Before operation, the CECD was (2582±344) cells/mm2 and (2578±322) cells/mm2 in OVD1 and OVD2 group, respectively; after operation for 1 month, CECD was (2241±547) cells/mm2 and (2152±580) cells/mm2, respectively. After t testing analysis, no statistical difference between them was found (t=-0.07, 0.16; P>0.05). Among of them, the patients with intraoperative phacoemulsification time exceeding 5 s in the preoperative OVD1 group and CECD of OVD2 were (2123±532) cell/mm2 and (1933±572 ) cell/mm2, respectively. The loss of corneal endothelial cells in OVD2 group was significantly higher than that of OVD1 group, and the difference was statistically significant (t=-2.69, P<0.05) . Before operation, CCT of patients in the OVD1 and OVD2 group were (518.6±32.7 )μm and (541.0±29.1)μm, respectively; the CCT of patients were (533.1± 36.7)μm and (526.7±36.8)μm, respectively. After t testing analysis, there was no significant difference between them (t=-1.01, -1.15; P>0.05). For patients whose operation time exceeded 5 s, the CCT of preoperative OVD1 group and OVD2 group was (519.3±37.6 )μm and (516.3±30.8)μm, respectively; at the following month were (537.3±40.8)μm and (531.5±39.2)μm, respectively. There was no statistically significant difference between them after t testing analysis (t=-1.03, -0.09; P>0.05). CECD of OVD1 and OVD2 groups was positively correlated with the duration and duration of intraoperative phacoemulsification, and Pearson correlation coefficient was used to evaluate the correlation. The difference was statistically significant (r=0.48, 0.36; P>0.05).

Conclusions

OVD1 was better in cohesive and dispersive properties compared to OVD2, which to protect corneal endothelial cells during cataract surgery if longer phaco power as used during the surgery.

Key words: Corneal endothelium, Viscosurgical devices, Cataract phacoemulsification
表1 两组患者术前与术后一个月角膜内皮细胞密度的比较
组别 例数 术前角膜内皮细胞密度(个细胞/mm2) 术后一个月角膜内皮细胞密度(个细胞/mm2)
OVD1组 67 2582±344 2241±547
OVD2组 168 2578±322 2152±580
t值   -0.07 0.16
P值   >0.05 >0.05
表2 术中超声乳化时间超过5s患者两组术前与术后一个月角膜内皮细胞密度的比较
组别 例数 术前角膜内皮细胞密度(个细胞/mm2) 术后一个月角膜内皮细胞密度(个细胞/mm2)
OVD1组 37 2491±370 2123±532
OVD2组 71 2566±329 1933±572
t值   -0.89 -2.69
P值   >0.05 <0.05
表3 两组患者术前与术后1个月角膜厚度的比较
组别 例数 术前角膜厚度(μm) 术后一个月角膜厚度(μm)
OVD1组 67 518.6±32.7 533.1±36.7
OVD2组 168 514.0±29.1 526.7±36.8
t值   -1.01 -1.15
P值   >0.05 >0.05
表4 术中超声乳化时间超过5 s患者两组术前与术后1个月角膜厚度的比较
组别 例数 术前角膜厚度(μm) 术后一个月角膜厚度(μm)
OVD1组 37 519.3±37.6 537.3±40.8
OVD2组 71 516.3±30.8 531.5±39.2
t值   -1.03 -0.09
P值   >0.05 >0.05
图1 OVD1组患者的CECD损失与术中超声乳化时间的关系
图2 OVD2组患者的CECD损失与术中超声乳化时间的关系
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