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目的了解外伤性无晶体眼患者角膜内皮的分布特点及二期人工晶体植入术对角膜内皮的影响。方法2004年12月至2005年5月于中山眼科中心外伤科2组的所有行二期人工晶体植入术的患者纳入本研究。测量患者术前术后角膜5个方位的角膜内皮细胞密度。比较术前术后角膜内皮细胞的变化。结果21例患者纳入研究,11例行上方角巩膜缘植入PMMA人工晶体,10例行在平坦部玻璃体腔内灌注下经上方角巩膜缘植入PMMA人工晶体缝襻固定术。术前伤口附近及上方角膜比其他位置的角膜的内皮细胞密度分别低417.8个/mm2及141.0个/mm2。二期人工晶体植入术后1周角膜内皮损失约129.2个/mm2,术后1个月比术后1周角膜内皮密度进一步下降。有眼内灌注及缝襻固定比无眼内灌注无缝襻固定的患者术后多丢失的角膜内皮数目大概为124个/mm2。术前角膜内皮细胞密度差异大,手术丢失的角膜内皮细胞的数目与术前角膜内皮细胞密度呈反比。结论多点测量角膜内皮为二期人工晶体植入术提供更客观全面的依据。手术丢失的角膜内皮细胞数目与术前角膜内皮细胞数目呈负相关。人工晶体手术切口应避免角膜穿通口位置。
Objective To investigate the distribution of corneal endothelium in patients with traumatic aphakia and the effect of second-stage intraocular lens implantation on corneal endothelium. Methods All patients underwent second-stage IOL implantation in two groups of Department of Traumatology, Zhongshan Eye Center from December 2004 to May 2005 were enrolled in this study. The corneal endothelial cell density at 5 orientations was measured before and after surgery. Corneal endothelial cells were compared before and after surgery. Results Twenty-one patients were included in the study. Eleven patients underwent upper limbal scleral implantation with PMMA intraocular lens and 10 patients underwent intraocular lens implantation with PMMA intraocular lens implantation in a flat portion under vitrectomy. The endothelial cell density in the cornea near the wounds and in the upper cornea was 417.8 / mm2 and 141.0 / mm2, respectively, lower than those before surgery. One week after the second intraocular lens implantation corneal endothelial loss of about 129.2 / mm2, 1 month after surgery than 1 week after the corneal endothelial density was further decreased. The number of corneal endothelium lost more than 124 eyes / mm2 after intraocular perfusion and suture fixation was higher than that without intraocular perfusion fixation. The density of preoperative corneal endothelial cells varied greatly, and the number of corneal endothelial cells lost by surgery was inversely proportional to the density of preoperative corneal endothelial cells. Conclusion The multi-point measurement of corneal endothelium provides more objective and comprehensive evidence for the second-stage intraocular lens implantation. The number of corneal endothelial cells lost by surgery was negatively correlated with the number of preoperative corneal endothelial cells. IOL surgical incision should avoid the location of corneal penetration.