【摘要】 目的 探讨高度近视合并白内障患者行飞秒激光辅助超声乳化术后的角膜内皮细胞变化情况以及影响因素。方法 回顾性分析2019年1月至2021年12月，高度近视合并白内障患者102例的临床资料，所有患者均接受飞秒激光辅助超声乳化术治疗，采用飞秒激光负压吸引固定眼球，制作2.2 mm透明角膜切口、5.0 mm环形撕囊并碎核，能量10μJ。术前1 d、术后1 d、术后7 d、术后1个月、术后6个月检测患者的视力、角膜内皮细胞计数变化情况。根据患者角膜内皮细胞的丢失程度分为一般丢失组和严重丢失组，对影响角膜内皮细胞变化的相关因素进行单因素分析和Logistic回归分析。结果 所有患者各时间点角膜内皮细胞计数以及裸眼近远视视力之间比较，差异具有显著意义(P<0.001)，术后7 d、术后1个月、术后6个月各指标明显优于术前1 d，术后7 d裸眼近远视视力明显优于术后1 d，且随术后时间延长呈明显改善趋势(P<0.001)。102例患者飞秒激光辅助超声乳化术手术过程均一次顺利完成，未出现明显的术中并发症，根据患者角膜内皮细胞的丢失程度：一般丢失组患者56例；严重丢失组患者46例。单因素分析结果显示：年龄、术前晶状体核硬度分级、术前前房深度和眼轴长度、术前IS/OS连续性、角膜散光度和眼底病变分级均是导致患者角膜严重丢失的重要影响因素；Logistic回归分析结果显示，年龄（OR=3.184,95%CI 2.036～4.977）、术前晶状体核硬度分级（OR=9.459,95%CI 3.212～27.854）、术前前房深度（OR=0.285,95%CI 0.132～0.613）、术前眼轴长度（OR=0.349,95%CI 0.216～0.563）、光感受器内外节连接性(IS/OS)(OR=4.884,95%CI 1.963～12.151)、角膜散光度（OR=0.305,95%CI 0.151～0.614）、眼底病变分级（OR=3.271,95%CI 1.795～5.958）均是导致患者角膜严重丢失的独立影响因素（P均<0.05）。结论 飞秒激光辅助白内障手术治疗高度近视合并白内障疗效明显，能够显著改善患者视力，但可能导致一定程度的角膜丢失，而年龄、术前晶状体核硬度分级、术前IS/OS连续性、角膜散光度和眼底病变分级以及术前房深度和眼轴长度均是影响角膜丢失严重程度的独立影响因素，临床中应予以适当关注。更多还原

【Abstract】 Objective To investigate the changes of corneal endothelial cells after femtosecond laser-assisted phacoemulsification in patients with high myopia and cataract and the influencing factors concerned.Methods A retrospective analysis was conducted on the clinical data of 102 patients who suffered both high myopia and cataract for treatment between Jan. 2019 and Dec. 2021. All the patients were given femtosecond laser assisted phacoemulsification treatment.Their eyeballs were fixed via femtosecond laser negative pressure suction,a 2. 2 mm transparent corneal incision was made, and 5. 0 mm circular capsulorhexis and nuclear fragmentation(10 μJ) was performed. The changes of their visual acuity and corneal endothelial cell count were measured respectively 1 d before the surgery and 1 d, 7 d, one month and six months after the surgery.According to the degree of loss of corneal endothelial cells, the patients were divided into a general loss group and a severe loss group.A univariate analysis and logistic regression analysis were conducted on the factors affecting the changes in corneal endothelial cells.Results There was a significant difference in corneal endothelial cell count and naked eye near and far sighted visual acuity among all patients at different time points(P<0. 001). The indicators got 7 d, one month and six months after the surgery were significantly better than those achieved 1 day before the surgery. The naked eye near and far sighted visual acuity measured 7 d after the surgery was much better than that measured 1 d after the surgery, indicating an obvious improvement with the prolongation of postoperative time(P<0. 001). The femtosecond laser assisted phacoemulsification surgery was successfully completed in all 102 patients without any significant intraoperative complication. According to the degree of corneal endothelial cell loss in the patients, 56 patients of general loss were allocated to the loss group, and 46 patients of severe loss to the severe loss group. It was reflected via the univariate analysis that age, preoperative lens hardness grade, preoperative anterior chamber depth and axial length, preoperative IS/OS continuity, corneal astigmatism and fundus lesion grade were all important factors leading to the severe corneal loss of the patients. It was shown via logistic regression analysis that age(OR=3. 184, 95% CI 2. 036-4. 977), preoperative lens hardness grade(OR=9. 459, 95% CI 3. 212-27. 854), preoperative anterior chamber depth(OR=0. 285, 95% CI 0. 132～0. 613), preoperative axial length(OR=0. 349, 95% CI 0. 216～0. 563), photoreceptor inner and outer segment connectivity(IS/OS)(OR=4. 884, 95% CI 1. 963～12. 151), corneal astigmatism(OR=0. 305, 95% CI 0. 151-0. 614) and grade of fundus lesions(OR=3. 271, 95% CI 1. 795-5. 958) were all independent factors leading to severe corneal loss(P<0. 05).Conclusions Femtosecond laser-assisted cataract surgery has obvious curative effect in treating high myopia combined with cataract and will significantly improve the vision of patients. However, it may lead to a certain degree of corneal loss in patients. Corneal astigmatism, grades of fundus lesions, preoperative chamber depth and axial length are independent factors affecting the severity of corneal loss, for which appropriate attention should be paid in clinical practice.更多还原