The Correlation between Cumulative Dissipated Energy and Corneal Endothelial Cells Loss during Ultrasonic Phacoemulsification

超音波白內障乳化手術其耗能與角膜內皮細胞喪失之關聯

蔡裕棋(Yu-Chi Tsai) ； 鄭惠川(Huey-Chuan Cheng)

《中華民國眼科醫學會雜誌》 51卷2期 (2012/10) Pp. 162-169

https://doi.org/10.30048/ACTASOS.201210.0009

摘要

目的：探討利用超音波乳化法去除白內障的手術中之耗能導致角膜內皮細胞喪失之間的關聯性，以提供減少手術帶來的創傷及提升白內障手術效率的參考。方法：本研究回溯自2010年6月至2011年3月間於台灣新竹馬借醫院接受白內障移除手術的119位病患。所有手術均由同一位醫師使用Alcon Infiniti Version 2.05以扭轉式超音波乳化法進行手術。手術時傷口的大小與位置、針頭的大小、注入瓶之高度及抽吸速率均盡可能保持一致。每位病患在手術前及手術後5～6星期均用Topcon FP-3000P測量中央角膜內皮細胞密度，並計算其喪失百分率。每一手術中之的耗能也一一記錄下來。結果：本研究之11 9病患的平均年齡為70±10歲、施用超音波時聞之平均值為18±11s、抽吸時間之平均值為129±36s、施用扭轉振幅之平均值為63±15%、流體使用之平均量為70±20 mL、平均耗能為4.9±4.0s、患眼手術後角膜內皮細胞喪失率為14±11%。重要的發現是其耗能與角膜內皮細胞喪失率間的關聯是線性關係，然而年齡與角膜內皮細胞喪失率間的關聯是指數關係。結論：本研究重要的發現：超音波白內障乳化手術其耗能越高則角膜內皮細胞喪失率也越高的線性關聯。再加上之前研究發現手術時採用高真空高抽吸速率可降低其耗能。因此我們獲得的結論是超音波白內障乳化手術若採用高真空高抽吸速率可降低其耗能，就可降低角膜內皮細胞喪失率。

並列摘要

Purpose: In order to provide a reference for less traumatic and more efficient cataract surgery, the surgical outcome of the relationship between cumulative dissipated energy (CDE) and corneal endothelia cell loss (ECL) during ultrasonic Phacoemulsification was investigated.Methods: A retrospective study was conducted of 119 patients who had a cataract extracted, between June 2010 and March 2011, in Hsin-Chu, Taiwan. All cataract surgeries were performed by the same surgeon, using torsional ultrasonic phacoemulsification with Alcon Infiniti Version 2.05. All of the following factors were constant: wound size and position, needle size, infusion bottle level, vacuum level and aspiration rate. The central corneal endothelial cell density (ECD) was recorded using Topcon FP-3000P, preoperatively and within 5~6 weeks after the surgery, and the ECL were then calculated for the lesion eyes of all 119 patients. The CDE for each surgery was then calculated.Results: The average age of the patients was 70±10 years. The mean total time for ultrasound (UST) was 18±11 s, mean aspiration time was 129±36 s, mean torsional amplitude was 63±15%, mean estimated fluid used was70±20 mL, mean CDE was 4.9±4.0 s, and the mean ECL of lesion eye was 14±11%. A significant linear increase in ECL of the lesion eye was observed as CDE increased. However, the correlation between age group and ECL exhibits an exponential relationship.Conclusions: This study reveals a linear correlation between mean ECL and CDE in ultrasonic phacoemulsification for the extraction of a cataract. A lower CDE generated in ultrasonic phacoemulsification may reduce the risk of corneal ECL, in cataract surgery.

並列關鍵字

cataract ； phacoemulsification ； cumulative dissipated energy ； corneal endothelial cell loss