白內障術後角膜內皮細胞的喪失

Corneal Endothelial Cell Loss after Cataract Surgery

張乙朝(Yee-Chau Chang) ； 胡芳蓉(Fung-Rong Hu) ； 柯良時(Liang-Shi Ko)

《中華民國眼科醫學會會刊》 26卷1期 (1987/05) Pp. 304-314

https://doi.org/10.30048/ACTASOS.198705.0055

摘要

我們選擇了60位做過單側白內障手術患者，利用廣角接觸式反射光顯微鏡檢查其角膜內皮細胞，並與對側正常眼比較以計算角膜內皮細胞喪失程度。在接受囊內白內障摘除術患者，角膜中心內皮細胞喪失為21.6%，合併前房人工水晶體植入者角膜內皮細胞喪失為27.5%，接受囊外白內障摘除術者角膜內皮細胞喪失為18.2%，合併後房人工水晶體植入者角膜內皮細胞喪失為12.7%，除中心部位外，亦測定角膜上、下部位內皮細胞喪失，顯示角膜內皮細胞喪失有垂直差異，此垂直差異與角膜中心內皮細胞喪失相關連。而每組手術眼與對照眼角膜中心厚度平均差值則與角膜中心內皮細胞喪失無關連性。由於上部角膜內皮細胞在術後傷害最大，細胞喪失也最多，這對以後病人若須再度施行眼內手術時，可提供手術方式之參考。
雖然合併前房人工水晶體植入術者之內皮細胞喪失值在統計上看來不比單純行囊內白內障摘除術來得有意義的大，但有併發症時，其結果會較嚴重，後房人工水晶體植入術只要小心操作到目前為止並未顯示對角膜內皮細胞造成更大傷害，但其長期追踪是必須的。
由於廣角接觸式反射光顯微鏡提供我們更清楚及更廣範圍的角膜內皮細胞檢查，使吾人對其變化能有進一步的了解。

並列摘要

Sixty patients after unilateral cataract operation underwent wide-field contact specular microscopic examination. All of the patients were divided into four groups. Endothelial cell loss was estimated by comparing the operated eye to the normal fellow eye. The central endothelial cell loss of intracapsular cataract extraction (Group A) was 2 1.6%, that of anterior chamber lens implantation (Group B) was 27.5%, that of extracapsular cataract extraction (Group C) was 18.2% and that of posterior chamber lens implantation (Group D) was 12.7%. Vertical disparity was also noted in all four groups and correlated to central endothelial cell loss.
Mean difference of central corneal thickness Sixty patients after unilateral cataract operation underwent wide-field contact specular microscopic examination. All of the patients were divided into four groups. Endothelial cell loss was estimated by comparing the operated eye to the normal fellow eye. The central endothelial cell loss of intracapsular cataract extraction (Group A) was 2 1.6%, that of anterior chamber lens implantation (Group B) was 27.5%, that of extracapsular cataract extraction (Group C) was 18.2% and that of posterior chamber lens implantation (Group D) was 12.7%. Vertical disparity was also noted in all four groups and correlated to central endothelial cell loss.
Mean difference of central corneal thickness between operated and control eyes in each group had no correlation to central endothelial cell loss.
Although the endothelial cell loss between group A and B was not significant, it would be much severer in complicated cases of anterior chamber lens implantation. At present, the posterior chamber lens implantation didn't cause much endothelial cell loss than simple extracapsular cataract extraction alone. Healon use and meticulous manipulation during intraocular lens implantation will be helpful to reduce the endothelial cell loss, but long-term follow up is necessary to ensure their safety.

並列關鍵字

endothelial cell loss ； cataract surgery ； conical thickness ； vertical disparity ； wide-field contact specular microscope