摘要
目的探讨小梁切除术中应用透明质酸钠对角膜内皮细胞数量和形态的影响。方法接受小梁切除术的原发性急性闭角型青光眼75例(75眼),随机分为两组:治疗组37例(37眼),前房内及巩膜瓣下注入1%透明质酸钠0.1ml并保留;对照组38例(38眼),则注入平衡盐溶液(BSS)0.1ml。采用非接触型角膜内皮显微镜分别于术前及术后第1周、第3个月进行角膜内皮细胞检查并分析其数量和形态参数的变化,同时观察术后眼压、前房形成情况、滤过泡及并发症。结果治疗组术前、术后第1周及第3个月角膜内皮细胞密度分别为(2183±325)个/mm2、(2096±332)个/mm2、(2112±261)个/mm2;平均细胞面积分别为(462.7±42.8)μm2、(422.9±53.1)μm2、(430.8±55.2)μm2;细胞面积变异系数分别为(47.3±15.7)%、(48.1±12.5)%、(42.6±10.9)%;六角型细胞百分率分别为(52.3±14.8)%、(51.6±13.3)%、(55.7±11.2)%;术后第1周及第3个月各参数与术前比较,差异均无统计学意义(P>0.05)。对照组术前、术后第1周及第3个月角膜内皮细胞密度分别为(2098±314)个/mm2、(1631±388)个/mm2、(1855±402)个/mm2;平均细胞面积分别为(462.7±42.8)μm2、(562.7±73.8)μm2、(536.6±65.1)μm2;细胞面积变异系数分别为(49.5±14.3)%、(59.2±12.6)%、(58.7±12.3)%;六角型细胞百分率分别为(53.2±16.1)%、(40.4±13.2)%、(42.6±11.8)%,术后第1周及第3个月的各参数与术前比较,差异均有统计学意义(P<0.05)。术后第1周及第3个月,治疗组的角膜内皮细胞损失率分别为4.0%及3.3%,均低于对照组的17.5%及11.6%(P<0.05)。治疗组术后浅前房发生的眼数、程度均低于对照组(P<0.05)。术后第1周及第3个月,不同前房深度组的角膜内皮损失率之间均有统计学差异(P<0.01)。术后前房深度越浅,角膜内皮细胞的损失率越大,两者有一定的相关关系(术后第1周r=0.7825,P<0.01;术后第3个月r=0.7603,P<0.01)。结论小梁切除术尤其是术后浅前房可引起角膜内皮细胞的损害,术中应用透明质酸钠可减少浅前房的发生及其程度,保护角膜内皮细胞。
Objective To investigate the effect of sodium hyaluronate （SH） on corneal endothelial cells in trabeculectomy.Methods Seventy-five patients （75 eyes） with primary acute closed-angle glaucoma underwent a trabeculectomy.SH was injected into the anterior chamber and under the sutured scleral flaps in 37 cases （37 eyes）,and in the other 38 cases （38 eyes）,the control group,it was injected into BSS.All cases had undergone tests for corneal endothelium cell density and cellular morphology with a non-contact corneal endothelial microscope before and 1 week and 3 months after the operation. Postoperative intraocular pressure （lOP）, the form of the anterior chamber, filtration and postoperative complications were compared between the two groups. Results The endothelium cell density, average cell area, cell size variation coefficient and percentage of hexagonal ceils before and 1 week and 3 months after the operation were （2183±325）mm^2, （2096±332）mm^2, （2112±261）mm^2 and （462.7±42.8）μm^2, （422.9±53.1）μm^2, （430.8±55.2）μm^2 and （47.3±15.7）%, （48.1±12.5）%, （42.6±10.9）% and （52.3±14.8）%, （51.6±13.3）%, （55.7±11.2）%, respectively, in the treatment group. The results for the control group were （2098±314） mm^2, （1631±388）mm^2, （1855±402）mm^2 and （462.7±42.8）μm^2, （562.7±73.8）μm^2, （536.6±65.1）μm^2 and （49.5 ±14.3）%, （59.2±12.6）%, （58.7±12.3）% and （53.2±16.1）%, （40.4±13.2）%, （42.6±11.8）%, respectively. There were no statistically significant differenees before the operation and 1 week or 3 months after the operation when endothelium cell density, average cell area, cell size variation coefficient and percentage of hexagonal cells in the treatment group were compared （P〉0.05）. But there were statistically significant differences in the control group （P〈0.05）. The loss rate of corneal endothelium cells in the treatment group was 4.0% and 3.3% at 1 week and 3 months after the operation. The rate was lower than the 17.5% and 11.6% in the control group （P〈0.05）. The shallow anterior chamber angle （in degrees） in the treatment group after the operation was lower than that in the control group （P〈0.05）. There were significant differences in the loss rate of corneal endothelium cells among the different anterior chamber angle groups before and 1 week or 3 months after the operation （P〈 0.01）. The more shallow the anterior chamber was, the higher the loss rate of corneal endothelium ceils. There was a positive correlation between the anterior chamber angle and loss rate of corneal endothelium cells 1 week or 3 months after the operation （r=0.7525, r=0.7603, respectively, P〈0.01）. Conclusion Trabeculectomy, especially in a postoperative shallow anterior chamber, can injure corneal endothelium cells. The use of sodium hyaluronate in trabcculectomy can decrease the occurrence and angle of a postoperative shallow anterior chamber and protect corneal endothelium
出处
《眼视光学杂志》
2009年第6期423-426,共4页
Chinese Journal of Optometry & Ophthalmology
基金
浙江省医药卫生优秀青年科技人才专项基金(2009QN024)
关键词
小梁切除术
透明质酸钠
角膜内皮细胞
trabeculectomy
sodium hyaluronate
corneal endothelium cell
