Department of Ophthalmology, Jeju National University Hospital, Jeju, Korea; the.
Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea; the; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea..
Can J Ophthalmol. 2019 Aug;54(4):438-444. doi: 10.1016/j.jcjo.2018.08.005. Epub 2018 Nov 10.
To investigate the extent of long-term corneal endothelial loss after uneventful cataract surgery and the factors associated with decreases in corneal endothelial cell density (ECD).
Retrospective case series.
Patients who had undergone uncomplicated cataract surgery.
This study comprised 81 eyes of 48 patients who had undergone cataract surgery >10 years previously by a single surgeon with the same intraocular lens and visited the outpatient clinic between January 2014 and February 2017. Long-term (≥10 years) changes in visual outcome and ECD after uncomplicated cataract surgery were evaluated. To analyze factors correlated with endothelial cell loss, preoperative biometric variables, including cataract grade, anterior chamber depth, axial length, and postoperative corneal edema, were evaluated.
The mean ± SD preoperative and long-term postoperative ECD was 2793 ± 351.09 and 2148 ± 478.38 cells/mm, respectively. The mean follow-up period was 11.08 ± 1.06 years and 10-year ECD loss rate was 20.62 ± 13.63%. Preoperative nuclear firmness was most statistically correlated with 10-year ECD loss (β-coefficient 0.394 [95% CI 3.402-9.448]; p < 0.001). The degree of postoperative corneal edema was also a significant predictive factor of 10-year ECD loss after cataract surgery (β-coefficient 0.378 [95% CI 2.854-8.358]; p = 0.002).
Preoperative nuclear firmness and postoperative corneal edema were predictors of long-term (≥10 years) endothelial cell loss and severe endothelial cell loss after cataract surgery. It is important to remember that eyes with increased nuclear firmness have a significantly higher risk of long-term enhanced ECL.
研究白内障手术后无并发症患者角膜内皮细胞长期丢失的程度，以及与角膜内皮细胞密度（ECD）下降相关的因素。
回顾性病例系列研究。
接受过单纯白内障手术的患者。
本研究纳入了 2014 年 1 月至 2017 年 2 月间由同一位医生进行白内障手术且植入相同人工晶状体的 48 例患者的 81 只眼。评估了无并发症白内障手术后长期（≥10 年）视觉效果和 ECD 的变化。为了分析与内皮细胞丢失相关的因素，评估了术前生物测量变量，包括白内障分级、前房深度、眼轴长度和术后角膜水肿。
平均（±SD）术前和长期术后 ECD 分别为 2793±351.09 和 2148±478.38 个细胞/mm。平均随访时间为 11.08±1.06 年，10 年 ECD 丢失率为 20.62±13.63%。术前核硬度与 10 年 ECD 丢失量最具统计学相关性（β 系数 0.394 [95%CI 3.402-9.448]；p<0.001）。白内障手术后角膜水肿的严重程度也是 10 年 ECD 丢失的一个显著预测因素（β 系数 0.378 [95%CI 2.854-8.358]；p=0.002）。
术前核硬度和术后角膜水肿是白内障手术后长期（≥10 年）内皮细胞丢失和严重内皮细胞丢失的预测因素。需要记住的是，核硬度增加的眼睛发生长期增强的 ECL 的风险显著增加。
