Effects of femtosecond laser-assisted phacoemulsification on corneal endothelial cells, visual quality and tear inflammatory indicators in cataract patients
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摘要:目的 探讨飞秒激光辅助超声乳化术对白内障患者角膜内皮细胞、视觉质量及泪液炎性指标的影响。方法 将2018年1—12月本院接受飞秒激光辅助超声乳化术治疗的72例(101眼)白内障患者设为观察组, 同期接受传统超声乳化术治疗的72例(98眼)患者为对照组。比较2组术中一般情况[前囊切口直径、囊膜大小、Ⅱ级核及Ⅲ级核累积释放能量(CDE)]、手术前后角膜内皮细胞相关指标[角膜内皮细胞密度、变异系数及六角形细胞比例]、视觉质量[最佳矫正视力(BCVA)、全眼总高阶像差(HOA)、总高阶像差下调制传递函数值(MTF)]及泪液炎性指标[白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及转化生长因子-β1(TGF-β1)]。结果 观察组术中前囊切开直径、囊膜大小、Ⅱ级核CDE、Ⅲ级核CDE均显著低于对照组(P < 0.05);术后3个月, 2组角膜内皮细胞密度、六角形细胞比例较术前均显著降低，变异系数显著升高(P < 0.05), 且观察组降低或升高幅度小于对照组(P < 0.05);术后1周、3个月, 2组BCVA均显著高于术前(P < 0.05)、HOA均显著低于术前(P < 0.05)、MTF值均显著高于术前(P < 0.05), 且观察组术后1周BCVA显著高于对照组(P < 0.05);术后1周、3个月，观察组HOA显著低于对照组(P < 0.05)、MTF值显著高于对照组(P < 0.05); 2组术后1周泪液炎性因子IL-6、IL-8、TNF-α及TGF-β1水平均较术前升高(P < 0.05)，但术后3个月IL-6、IL-8、TNF-α及TGF-β1水平逐渐恢复至正常，且组间比较差异均无统计学意义(P>0.05)。结论 与传统超声乳化术比较，飞秒激光辅助超声乳化术对白内障患者角膜内皮细胞损伤更小，患者术后早期可获得更好视觉质量，但在术后泪液炎性指标控制方面无明显优势。Abstract:Objective To explore the effects of femtosecond laser-assisted phacoemulsification on corneal endothelial cells, visual quality and tear inflammatory indicators in cataract patients.Methods A total of 72 patients (101 eyes) with cataract who underwent femtosecond laser-assisted phacoemulsification in our hospital from January to December 2018 were selected as observation group. Another 72 patients (98 eyes) who underwent traditional phacoemulsification were included in control group. The intraoperative general indicators [incision diameter of anterior capsule, size of capsule membrane, cumulative dissipated energy of grade Ⅱ nucleus and grade Ⅲ nucleus (CDE)], and pre-and post-operative corneal endothelial cells-related indicators [corneal endothelial cell density, coefficient of variation and proportion of hexagonal cells], visual quality [best corrected visual acuity (BCVA), total higher order aberration (HOA), modulation transfer function (MTF)] and tear inflammatory indicators[interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1)] before and after surgery were compared between the two groups.Results The incision diameter of anterior capsule, eye capsule membrane size, grade Ⅱ nucleus CDE and grade Ⅲ nucleus CDE in observation group were significantly lower than those in control group (P < 0.05). At 3 months after surgery, the corneal endothelial cell density and proportion of hexagonal cells in the two groups were significantly decreased compared with before surgery, while the coefficient of variation was significantly increased (P < 0.05), and the degree of decreases or increase in observation group were smaller than those in control group (P < 0.05). The BCVA and MTF values at 1 week and 3 months after surgery in the two groups were significantly higher than that before operation (P < 0.05), while the HOA was significantly lower than that before operation (P < 0.05); and the BCVA in observation group at 1 week after surgery was significantly higher than that in control group (P < 0.05), and the HOA at 1 week and 3 months after surgery in the observation group was significantly lower than that in control group (P < 0.05), while the MTF value was significantly higher than that in control group (P < 0.05). The levels of tear inflammatory factors such as IL-6, IL-8, TNF-α and TGF-β1 in the two groups at 1 week after surgery were increased compared with surgery before (P < 0.05), but were gradually returned to normal at 3 months after surgery, and there were no significant differences between the two groups (P>0.05).Conclusion Compared with traditional phacoemulsification, femtosecond laser-assisted phacoemulsification has less damage to corneal endothelial cells in cataract patients, and can gain better visual quality in early postoperative period, but it has no obvious advantage in control of postoperative tear inflammatory indicators.
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表 1 2组术中情况比较(x±s)
组别 前囊切开直径/mm 囊膜大小/mm Ⅱ级核CDE/% Ⅲ级核CDE/% 观察组(n=101眼) 5.02±0.11* 27.45±11.27* 6.57±2.36* 18.12±4.35* 对照组(n=98眼) 5.88±0.15 34.86±12.05 8.62±2.51 21.62±4.46 CDE:累积释放能量。与对照组比较, *P < 0.05。 
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表 2 2组术前、术后3个月角膜内皮细胞相关指标比较(x±s)
组别 内皮细胞密度/(个/mm2) 变异系数/% 六角形细胞比例/% 术前 术后3个月 术前 术后3个月 术前 术后3个月 观察组(n=101眼) 2 519.65±235.64 2 215.11±214.06*# 26.76±4.11 31.52±5.04*# 53.26±4.72 44.87±4.85*# 对照组(n=98眼) 2 524.47±242.83 2 116.72±186.95* 26.54±4.28 35.59±5.15* 53.39±4.48 37.88±3.43* 与术前比较, *P < 0.05;与对照组比较, #P < 0.05。
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表 3 2组手术前后视觉质量比较(x±s)
组别 时点 BCVA HOA/μm MTF 观察组(n=101眼) 术前 0.31±0.08 0.79±0.26 0.27±0.09 术后1周 0.98±0.05*# 0.24±0.07*# 0.46±0.10*# 术后3个月 0.99±0.09* 0.09±0.04*Δ# 0.56±0.11*Δ# 对照组(n=98眼) 术前 0.32±0.07 0.76±0.23 0.28±0.07 术后1周 0.95±0.08* 0.32±0.09* 0.38±0.09* 术后3个月 0.97±0.08* 0.14±0.06*Δ 0.45±0.10*Δ BCVA:最佳矫正视力; HOA:总高阶像差; MTF:总高阶像差下调制传递函数值。
与术前比较, *P < 0.05;与术后1周比较, ΔP < 0.05;与对照组比较, #P < 0.05。
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表 4 2组术前、术后1周、术后3个月泪液炎性因子水平比较(x±s)
pg/mL 组别 时点 IL-6 IL-8 TNF-α TGF-β1 观察组(n=101眼) 术前 1.57±0.28 1.75±0.32 1.97±0.29 84.82±7.88 术后1周 2.44±0.31* 3.15±0.41* 4.22±0.37* 124.69±9.52* 术后3月 1.61±0.35*# 1.82±0.42*# 2.08±0.44*# 86.15±8.64*# 对照组(n=98眼) 术前 1.56±0.34 1.76±0.23 1.95±0.34 85.12±8.23 术后1周 2.38±0.36* 3.08±0.39* 4.08±0.46* 122.75±9.91* 术后3月 1.57±0.41*# 1.79±0.44*# 2.02±0.42*# 86.02±8.92*# IL-6:白介素-6; IL-8:白介素-8; TNF-α:肿瘤坏死因子-α; TGF-β1:转化生长因子-β1。
与术前比较, *P < 0.05;与术后1周比较, #P < 0.05。
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