白内障患者术前角膜内皮功能分析

摘要

目的 分析不同白内障患者术前角膜内皮结构,以指导制定合理的个性化手术方案.方法 前瞻性病例系列研究.白内障患者1910例(3423眼),按合并疾病的不同分组:A组为年龄相关性白内障组,1511例;B组为合并青光眼组,22例;C组为合并2型糖尿病组,179例.再将A组按年龄段分为40～59岁组,60～79岁组,≥80岁组(高龄组).所有患者术前检测角膜内皮细胞密度(CD)、细胞平均面积(AVE)、六棱细胞比例(HEXA)等.采用单因素方差分析进行整体比较,组内两两之间差异采用Tukev法.结果 与A组相比,B组CD较低、AVE较大,差异有统计学意义(P＜0.05),HEX较少,但差异无统计学意义;C组CD较低、AVE较大、HEXA较少,但与A组相比,差异均无统计学意义.按年龄分组,≥80岁组白内障患者角膜内皮CD较低、AVE较大、HEXA较少,与40～59岁组、60～79岁组相比,差异有统计学意义(P＜0.05).结论 青光眼可导致角膜内皮细胞密度下降,平均细胞面积增大;糖尿病对角膜内皮细胞形态没有明显影响.随年龄增长,年龄相关性白内障患者的角膜内皮细胞密度下降,平均细胞面积增大,六棱细胞比例减小.%Objective To evaluate structure of corneal endothelium of different kind of cataract,so to guide reasonable individual surgery scheme. Methods Prospective case series study.One thousand nine hundred and ten patients with cataract divided into 3 groups, group A (age-related cataract), group B(cataract accompany with glaucoma), group C (cataract accompany with non-insulin dependent diabetes). Group A were divided into 3 groups by age: group 1, 40-59 years old, group 2, 60-79 years old, and group 3 were 80 years old or oder. All patients were under endothelium cell density (CD), AVE, HEXA before surgery. The results were analyzed with One-Way ANOVA. Results Compared with group A, there were lower CD and higher AVE in group B (P＜0.05), HEXA was lower but without any significance. In group C there were lower CD, higher AVE,lower HEXA, but without any significance compare to group A. In group A, advanced aged patients have lower CD, higher AVE, lower HEXA (P＜0.05 for all). Conclusion Glaucoma would make CD decreased, AVE enlarged; diabete has little effect on the structure of corneal endothelium. With age advancing, CD decreasing, AVE enlarging, ratio of HEXA decreasing in age-related cataract.