Sorrentino Francesco Saverio, Matteini Silvia, Imburgia Aurelio, Bonifazzi Claudio, Sebastiani Adolfo, Parmeggiani Francesco
Department of Surgical Sciences, Unit of Ophthalmology, Ospedale Maggiore, Bologna, Italy.
Department of Biomedical and Surgical Sciences, Division of Ophthalmology, University of Ferrara, Ferrara, Italy.
PLoS One. 2017 Oct 26;12(10):e0186975. doi: 10.1371/journal.pone.0186975. eCollection 2017.
To study the effect of torsional phacoemulsification energy on corneal endothelium evaluating the relationship between changes of endothelial cells and postoperative visual acuity.
This prospective clinical observational cohort study included 50 patients with cataract who underwent torsional phacoemulsification. Sequential quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed four weeks preoperatively and six weeks postoperatively using noncontact specular microscopy.
This work confirmed the strong relationship, described by a linear model (one-way ANOVA, R2 = 77.9%, P < 0.0001), between the percentage of endothelial cell loss (ECL%) and the 5-score harm scale. According to the Tukey post-hoc pairwise comparison test, distinct values of ECL% are grouped in 3 subsets. The value of ECL = 10% has been identified as cut-off to discriminate patients with excellent postoperative best-corrected visual acuity (BCVA > 85 letters) from those with just a good/satisfied visual outcome (BCVA ≤ 85 letters). Within the 5-score harm scale, there was a significant correlation among phaco energy intraoperatively delivered and the average endothelial cell loss.
This study confirms the validity of the 5-score harm scale first proposed by Sorrentino and colleagues in 2016. This time, the method categorizes cataracts taking into account nucleus hardness and phaco cumulative dissipated energy. Predicting the harm on corneal endothelium, we can discriminate patients with excellent BCVA and with just good/satisfied BCVA. With torsional phacoemulsification with respect to longitudinal, the percentage of patients who can reach excellent BCVA is remarkably increased.
研究扭转式超声乳化能量对角膜内皮的影响，评估内皮细胞变化与术后视力之间的关系。
这项前瞻性临床观察队列研究纳入了50例行扭转式超声乳化术的白内障患者。术前4周和术后6周使用非接触式角膜内皮显微镜对角膜进行连续的定量和定性形态学内皮细胞分析。
本研究证实了内皮细胞损失百分比（ECL%）与5分危害量表之间存在线性模型描述的强相关性（单因素方差分析，R2 = 77.9%，P < 0.0001）。根据Tukey事后两两比较检验，ECL%的不同值分为3个亚组。已确定ECL = 10%为区分术后最佳矫正视力（BCVA > 85字母）优秀的患者与视力良好/满意（BCVA≤85字母）的患者的临界值。在5分危害量表范围内，术中传递的超声乳化能量与平均内皮细胞损失之间存在显著相关性。
本研究证实了2016年Sorrentino及其同事首次提出的5分危害量表的有效性。此次，该方法在考虑核硬度和超声乳化累积耗散能量的情况下对白内障进行分类。通过预测对角膜内皮的损害，我们可以区分BCVA优秀和BCVA良好/满意的患者。与纵向超声乳化相比，采用扭转式超声乳化可显著提高达到BCVA优秀的患者比例。
