PDF(Pubmed)
Abstract：
The aim of this study was to evaluate the influence of ultrasounds used in phacoemulsification during cataract surgery on the corneal structure and morphology in patients over 65 years. We compared the outcomes of phacoemulsification techniques in terms of corneal cell morphology in 77 patients over 65 years old and 43 patients under 65 years old. Corneal cell density, central corneal thickness and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of gender, axial length and anterior chamber depth on the parameters of corneal endothelium were evaluated. In both groups, a progressive decrease in endothelial cells was observed, starting from the first week post-surgery until the fourth postoperative week. The central corneal thickness increased in both groups with maximum values at the first week postoperatively, while their initial values were restored in the fourth week post-surgery, with no statistical difference between groups. Statistically significant differences were noticed in terms of cell hexagonality in the group over 65, showing smaller hexagonality at all preoperative and postoperative time points compared to group under 65. Our result highlights the importance of routine specular microscopy performed before surgery, regardless the age of the patients, with caution and careful attention to the phaco power intensity, ultrasound energy consumption and intraoperative manipulation of instruments, as well as proper use of viscoelastic substances to reduce corneal endothelium damage, especially in elderly patients.
摘要：
这项研究的目的是评估65岁以上患者在白内障手术中超声乳化术对角膜结构和形态的影响。我们比较了77例65岁以上患者和43例65岁以下患者的超声乳化技术在角膜细胞形态方面的结果。角膜细胞密度,术前和术后(1周和4周)通过镜面反射显微镜测量中央角膜厚度和六边形。性别的影响，轴向长度和前房深度对角膜内皮参数进行评估。在这两组中,观察到内皮细胞逐渐减少，从术后第一周开始直到术后第四周。两组的中央角膜厚度均在术后第1周达到最大值,虽然它们的初始值在手术后的第四周恢复，组间无统计学差异。65岁以上组的细胞六角形性具有统计学上的显着差异，与65岁以下组相比，在术前和术后所有时间点的六角形性较小。我们的结果突出了手术前常规镜面反射显微镜的重要性，不管病人的年龄,谨慎小心地注意超声波功率强度，超声能量消耗和术中操作器械，以及适当使用粘弹性物质来减少角膜内皮损伤，尤其是老年患者。
