Dick B, Kohnen T, Jacobi K W
Universitäts-Augenklinik Giessen.
Ophthalmologe. 1995 Aug;92(4):476-83.
This prospective study was performed to compare the central endothelial cell loss (ECL) after phacoemulsification and 3.5 with 5 mm temporal clear-corneal incision. Moreover, the influence of ultrasound time and power on postoperative endothelial cell density was evaluated. PATIENTS AND METHODS. Sixty-two patients (age 71 +/- 7.7 years) without corneal pathology were operated by phacoemulsification (Storz, Premiere) with a temporal, self-sealing, two-step clear-corneal incision followed by posterior chamber IOL implantation under viscoelastic (1% sodium hyal-uronate). Thirty-one one-piece plate-haptic foldable silicone IOLs (Chiron C10; Staar Surgical AA-4203) were implanted by an injector through a 3.5 mm incision (group A). The other 31 PMMA IOLs (Pharmacia 809P) were implanted through a 5 mm incision (group B). One surgeon performed all operations with the same technique (bimanual phacoemulsification in the capsular bag). Sutureless wound closure was performed in group A, while the wounds in patients of group B were closed with a single radial stitch. The central endothelial cell counts were recorded preoperatively, on days 2-5 and 6 months postoperatively using contact specular microscopy. RESULTS. The collective data revealed a cell loss of 7.9% (+/- 4.1 SD) on days 2-5 postoperatively and 6.7% (+/- 2.9) after 6 months. A direct linear relationship was found to exist between ultrasound time (UT) and ECL. In group A (7 patients) the ECL slightly increased from 3.5% in the first week postoperatively to 3.8% after 6 months, operated under UT < or = 1 min 30 sec. The ECL decreased from 8.2% to 6.4% after 6 months in group A (19 patients), operated under UT of 1 min 30 sec, and from 10.8% to 8.9% under UT of 2 min 31 sec-3 min 30 sec (5 patients). The ECL in group B decreased from 6.3% in the first postoperative week to 5.4% 6 months postoperatively, operated under UT < or = 1 min 30 sec (10 patients), from 8.1% to 7%, operated under UT of 1 min 31 sec-2 min 30 sec (14 patients), and from 11.2% to 10.4% under UT of 2 min 31 sec-3 min 30 sec (7 patients). CONCLUSION. Endothelial cell loss of 6.7% after phacoemulsification through a temporal clear-corneal incision compares favorably with other series in which cell loss was determined following cataract surgery with or without IOL implantation. Phacoemulsification and 3.5 mm clear-corneal incision evoked less ECL of 6.2% compared with phacoemulsification and 5 mm clear-corneal incision with ECL of 7.3% after 6 months.
本前瞻性研究旨在比较超声乳化白内障吸除术采用3.5mm与5mm颞侧透明角膜切口后的中央内皮细胞丢失（ECL）情况。此外，还评估了超声时间和功率对术后内皮细胞密度的影响。患者与方法：62例无角膜病变的患者（年龄71±7.7岁）接受了超声乳化白内障吸除术（Storz，Premiere），采用颞侧自封闭两步式透明角膜切口，随后在粘弹剂（1%透明质酸钠）下植入后房型人工晶状体。31枚一体式板袢可折叠硅凝胶人工晶状体（Chiron C10；Staar Surgical AA - 4203）通过3.5mm切口由注射器植入（A组）。另外31枚聚甲基丙烯酸甲酯人工晶状体（Pharmacia 809P）通过5mm切口植入（B组）。由一位外科医生采用相同技术（囊袋内双手超声乳化）完成所有手术。A组采用无缝线伤口闭合，而B组患者的伤口用单根放射状缝线闭合。术前、术后第2 - 5天以及术后6个月使用接触式镜面显微镜记录中央内皮细胞计数。结果：总体数据显示术后第2 - 5天细胞丢失率为7.9%（±4.1标准差），6个月后为6.7%（±2.9）。发现超声时间（UT）与ECL之间存在直接线性关系。在A组（7例患者）中，超声时间≤1分30秒时，术后第一周ECL从3.5%略有增加至6个月后的3.8%。A组（19例患者）超声时间为1分30秒时，6个月后ECL从8.2%降至6.4%；超声时间为2分31秒至3分30秒时（5例患者），ECL从10.8%降至8.9%。B组超声时间≤1分30秒时（10例患者），术后第一周ECL从6.3%降至术后6个月的5.4%；超声时间为1分3l秒至2分30秒时（14例患者）从8.1%降至7%；超声时间为2分31秒至3分30秒时（7例患者）从11.2%降至10.4%。结论：经颞侧透明角膜切口超声乳化白内障吸除术后6.7%的内皮细胞丢失率与其他系列研究相比具有优势，其他系列研究在有或无人工晶状体植入白内障手术后测定细胞丢失率。与超声乳化白内障吸除术联合5mm透明角膜切口（6个月后ECL为7.3%）相比，超声乳化白内障吸除术联合3.5mm透明角膜切口引起的ECL较少，为6.2%。
