Analysis of corneal endothelial changes and influencing factors after modified four point fixed intraocular lens suspension implantation in aphakic eyes
Objective To observe the changes in corneal endothelium after modified four point fixed intraocular lens suspension implantation in patients with aphakia and analyze its influencing factors.Methods Retrospective cases study.78 patients(78 eyes)with aphakia who successfully underwent modified four point fixed intraocular lens suspension surgery in our hospital from June 2021 to October 2022 were included.The uncorrected visual acuity(UCVA),best cor-rected visual acuity(BCVA),corneal endothelial cell density(CECs),coefficient of variation(CV)of cell area,and hex-agonal ratio were recorded before,at 1 and 3 months after the surgery,single factor analysis and binary logistic regression analysis were used to analyze the risk factors affecting corneal endothelial injury.Results At one month after the surgery,the UCVA was logMAR(0.49±0.23),and at three months after the surgery,the UCVA was logMAR(0.39±0.17),with a statistically significant difference compared to before the surgery(t=27.60,29.18,P=0.00,0.00).At one month after the surgery,the BCVA was logMAR(0.41±0.18),and at three months after the surgery,the BCVA was logMAR(0.36±0.14),with no statistically significant difference compared to before surgery(t=1.34,1.94,P=0.18,0.05).The CECs was(2 515.97±291.40)/mm2 before the surgery,and(2377.61±288.50)/mm2 one month after the surgery,with a statistically sig-nificant difference compared to before the surgery(t=16.01,P=0.00).The CECs at three months after the surgery were(2 320.70±287.37)/mm2,with a statistically significant difference compared to before the surgery(t=20.24,P=0.00),and with a statistically significant difference compared to one month after the surgery(t=15.79,P=0.00).The coefficient of variation(CV)of cell area was(40.15±2.80)%before the surgery,(42.43±3.25)%at 1 month after the surgery,which was statistically significant compared to before the surgery(t=-15.29,P=0.00),and(44.14±3.40)%at 3 months after the surgery,which was statistically significant compared to before the surgery(t=-21.47,P=0.00).The difference was statisti-cally significant compared to 1 month after the surgery(t=-18.28,P=0.00).The preoperative hexagonal ratio was(42.51±5.16)%,the 1-month postoperative hexagonal ratio was(39.17±4.98)%,with a statistically significant difference com-pared to preoperative(t=21.88,P=0.00),and the 3-month postoperative hexagonal ratio was(36.03±6.14)%,with a statis-tically significant difference compared to preoperative(t=11.51,P=0.00),and the 1-month postoperative difference was statistically significant(t=6.07,P=0.00).Univariate analysis showed that there was no correlation between age,intraocular pressure,baseline corneal endothelial cell density and corneal endothelial cell injury(F=1.13,2.09,0.14,P=0.29,0.15,0.70),and there was no correlation between gender,eye type,open corneal injury,diabetes and corneal endothelial cell injury(χ2=0.00,2.62,1.41,2.22,P=1.00,0.10,0.23,0.13),Anterior chamber perfusion and limbal incision are risk fac-tors for corneal endothelial cell injury(χ2=4.16,14.97,P=0.04,0.00),and binary logistic regression analysis shows that an-terior chamber perfusion and limbal incision were independent risk factors for corneal endothelial cell injury(OR=5.63,0.08,P=0.00,0.00).Conclusions Patients with aphakia undergoing modified four point scleral fixed intraocular lens sus-pension implantation have significantly improved visual acuity,decreased corneal endothelial cell density,increased coeffi-cient of variation of cell area,decreased hexagonal ratio,and significant corneal endothelial cell damage.Corneal limbal incision and anterior chamber perfusion are independent risk factors affecting corneal endothelial cell damage.
Aphakic eyesFour point fixationArtificial lens suspension surgeryCorneal endothelium
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