中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2011年
6期
555-561
,共7页
超声生物显微镜%前房容积%前房角%前房深度%超声乳化白内障吸除术%后房型人工晶状体
超聲生物顯微鏡%前房容積%前房角%前房深度%超聲乳化白內障吸除術%後房型人工晶狀體
초성생물현미경%전방용적%전방각%전방심도%초성유화백내장흡제술%후방형인공정상체
Ultrasound biomicroscopy%Anterior chamber cubage%Anterior chamber angle%Anterior chamber distance%Phacoemulsification%Posterior chamber intraocular lens
目的 应用超声生物显微镜(ultrasound biomicroscopy UBM)量化观察具有浅前房、窄房角结构和正常前房深度、宽房角结构的白内障患者在行了白内障超声乳化人工晶状体植入术后前房容积的改变,旨在探讨白内障手术对前房容积的影响,对手术时机的选择提供安全有效的临床依据.方法 选取具有浅前房、窄房角结构和正常前房深度、宽房角结构的白内障患者作为对照组,每组患者各40例(40只眼),均采用透明角膜切口白内障超声乳化后房型人工晶状体植入术,于术前和术后1个月用UBM观测前房深度(ACD)、小梁虹膜夹角(TIA)、房角开放距离(AOD250、AOD500)、小梁睫状体距离(TCPD)、虹膜睫状体距离(ICPD)、虹膜晶状体接触距离(ILCD)和前房角隐窝面积(ARA),同时记录眼压的变化和各级房角的人数构成比,对结果进行比较分析.结果 全部患者术后除ILCD值比术前明显减小以外,其余各项值ACD、TIA、AOD250、AOD500、TCPD、ICPD、ARA均较术前明显增加,差异具有统计学意义(P <0.001).术后眼压平均下降(3.77143±1.84368)mmHg,较术前差异有统计学意义(P<0.001).对宽房角组患者进行手术前后的比较,各测量值均较术前明显增加,差异有统计学意义(P<0.001),术后眼压平均下降(2.49714±1.05482)mmHg,较术前明显下降(P<0.001).对窄房角组患者进行手术前后的比较,术后各测量值比术前大大增加,差异具有显著统计学意义(P<0.001),术后眼压较术前明显降低,平均下降(5.04571±1.56287)mmHg,差异有统计学意义(P<0.001 ).分别对窄房角组和宽房角组患者进行术前结构的比较和术后结构的比较,除ICPD值外,其余各值二组间均存在显著性差异有统计学意义(P<0.001).将二组患者手术前后的变化程度进行比较,窄房角组ACD、AOD250、AOD500、TIA、ARA值的变化程度显著大于宽房角组,差异具有显著统计学意义(P<0.01).手术前后的房角构成差异有统计学意义(P <0.001),术后宽角显著增多.结论 白内障超声乳化吸除人工晶体植入术后,前房加深,房角增宽,前房容积显著增加,眼压也有一定程度的下降.具有浅前房、窄房角结构的白内障患者,手术前、后的变化程度更为显著.UBM可以明确有无晶体因素引起的瞳孔阻滞,当发现此情况时,可以将白内障手术时机提早,使具有窄房角解剖因素的白内障患者避免因晶体膨胀、瞳孔阻滞而引起的青光眼的发生,在一定程度上起到预防的作用.
目的 應用超聲生物顯微鏡(ultrasound biomicroscopy UBM)量化觀察具有淺前房、窄房角結構和正常前房深度、寬房角結構的白內障患者在行瞭白內障超聲乳化人工晶狀體植入術後前房容積的改變,旨在探討白內障手術對前房容積的影響,對手術時機的選擇提供安全有效的臨床依據.方法 選取具有淺前房、窄房角結構和正常前房深度、寬房角結構的白內障患者作為對照組,每組患者各40例(40隻眼),均採用透明角膜切口白內障超聲乳化後房型人工晶狀體植入術,于術前和術後1箇月用UBM觀測前房深度(ACD)、小樑虹膜夾角(TIA)、房角開放距離(AOD250、AOD500)、小樑睫狀體距離(TCPD)、虹膜睫狀體距離(ICPD)、虹膜晶狀體接觸距離(ILCD)和前房角隱窩麵積(ARA),同時記錄眼壓的變化和各級房角的人數構成比,對結果進行比較分析.結果 全部患者術後除ILCD值比術前明顯減小以外,其餘各項值ACD、TIA、AOD250、AOD500、TCPD、ICPD、ARA均較術前明顯增加,差異具有統計學意義(P <0.001).術後眼壓平均下降(3.77143±1.84368)mmHg,較術前差異有統計學意義(P<0.001).對寬房角組患者進行手術前後的比較,各測量值均較術前明顯增加,差異有統計學意義(P<0.001),術後眼壓平均下降(2.49714±1.05482)mmHg,較術前明顯下降(P<0.001).對窄房角組患者進行手術前後的比較,術後各測量值比術前大大增加,差異具有顯著統計學意義(P<0.001),術後眼壓較術前明顯降低,平均下降(5.04571±1.56287)mmHg,差異有統計學意義(P<0.001 ).分彆對窄房角組和寬房角組患者進行術前結構的比較和術後結構的比較,除ICPD值外,其餘各值二組間均存在顯著性差異有統計學意義(P<0.001).將二組患者手術前後的變化程度進行比較,窄房角組ACD、AOD250、AOD500、TIA、ARA值的變化程度顯著大于寬房角組,差異具有顯著統計學意義(P<0.01).手術前後的房角構成差異有統計學意義(P <0.001),術後寬角顯著增多.結論 白內障超聲乳化吸除人工晶體植入術後,前房加深,房角增寬,前房容積顯著增加,眼壓也有一定程度的下降.具有淺前房、窄房角結構的白內障患者,手術前、後的變化程度更為顯著.UBM可以明確有無晶體因素引起的瞳孔阻滯,噹髮現此情況時,可以將白內障手術時機提早,使具有窄房角解剖因素的白內障患者避免因晶體膨脹、瞳孔阻滯而引起的青光眼的髮生,在一定程度上起到預防的作用.
목적 응용초성생물현미경(ultrasound biomicroscopy UBM)양화관찰구유천전방、착방각결구화정상전방심도、관방각결구적백내장환자재행료백내장초성유화인공정상체식입술후전방용적적개변,지재탐토백내장수술대전방용적적영향,대수술시궤적선택제공안전유효적림상의거.방법 선취구유천전방、착방각결구화정상전방심도、관방각결구적백내장환자작위대조조,매조환자각40례(40지안),균채용투명각막절구백내장초성유화후방형인공정상체식입술,우술전화술후1개월용UBM관측전방심도(ACD)、소량홍막협각(TIA)、방각개방거리(AOD250、AOD500)、소량첩상체거리(TCPD)、홍막첩상체거리(ICPD)、홍막정상체접촉거리(ILCD)화전방각은와면적(ARA),동시기록안압적변화화각급방각적인수구성비,대결과진행비교분석.결과 전부환자술후제ILCD치비술전명현감소이외,기여각항치ACD、TIA、AOD250、AOD500、TCPD、ICPD、ARA균교술전명현증가,차이구유통계학의의(P <0.001).술후안압평균하강(3.77143±1.84368)mmHg,교술전차이유통계학의의(P<0.001).대관방각조환자진행수술전후적비교,각측량치균교술전명현증가,차이유통계학의의(P<0.001),술후안압평균하강(2.49714±1.05482)mmHg,교술전명현하강(P<0.001).대착방각조환자진행수술전후적비교,술후각측량치비술전대대증가,차이구유현저통계학의의(P<0.001),술후안압교술전명현강저,평균하강(5.04571±1.56287)mmHg,차이유통계학의의(P<0.001 ).분별대착방각조화관방각조환자진행술전결구적비교화술후결구적비교,제ICPD치외,기여각치이조간균존재현저성차이유통계학의의(P<0.001).장이조환자수술전후적변화정도진행비교,착방각조ACD、AOD250、AOD500、TIA、ARA치적변화정도현저대우관방각조,차이구유현저통계학의의(P<0.01).수술전후적방각구성차이유통계학의의(P <0.001),술후관각현저증다.결론 백내장초성유화흡제인공정체식입술후,전방가심,방각증관,전방용적현저증가,안압야유일정정도적하강.구유천전방、착방각결구적백내장환자,수술전、후적변화정도경위현저.UBM가이명학유무정체인소인기적동공조체,당발현차정황시,가이장백내장수술시궤제조,사구유착방각해부인소적백내장환자피면인정체팽창、동공조체이인기적청광안적발생,재일정정도상기도예방적작용.
Objective To study and analyze the changes of anterior chamber cubage of senile cataract patients before and after the surgery of phacoemulsification and foldable IOL implantation with ultrasound biomicroscopy quantitatively, to explore the influence of anterior chamber angle and anterior chamber cubage caused by senile cataract, and to provide safe and effective basis of cataract surgery options.Methods Small-incision phacoemulsification and foldable IOL implantation start from transparent cornea were performed in 80 eyes of 80 senior patients whom were divided into two groups: one group with normal anterior chamber structure, another group of shallow anterior chamber and narrow anterior chamber angle, measured numerical values of ACD (anterior chamber distance), AOD250 (angle-opening distance at 250μ m from the scleral spur)and AOD500 (angle-opening distance at 500μ m from the scleral spur), TIA500 (trabecular iris angle at 500μ m from the scleral spur), Trabecular ciliary processes distance (TCPD), iris ciliary body distance (ICPD),iris lens contact distance (ILCD) and angle recess area (ARA).At the same time, the intraocular pressures were also recorded.The number of people at all levels of composition ratio of angle and intraocular pressure by using ultrasound biomicroscopy before operation and one month later to analysis.Results In all patients, the measurements of ACD, AOD250, AOD500, TIA, TCPD, ICPD, and ARA were increased significantly after the operation except for ILCD after the operation.The intraocular pressure was also reduced to some extent after the operation.There were significant differences between two groups in ACD, AOD250, AOD500, TIA, TCPD,ICPD, and ARA except for ICPD before and after the surgery.The measurements and the intraocular pressure change more in the group of shallow anterior chamber caused by senile cataract.To compare the extent of change in two groups, the degree of change in group with narrow anterior chamber angle was significantly greater than in normal eyes group.The composition of angle had statistically significant difference pre-operation and post-operation (P<0.001), and wide-angle increased significantly after surgery.Conclusions Small incision phacoemulsification and foldable IOL implantation surgery deepens the anterior chamber, widens anterior chamber angle and increases anterior chamber cubage significantly compared with the preoperative patients,and it also reduces intraocular pressure to some extent after the operation.The added value of anterior chamber cubage is more prominent in the patients with narrow anterior chamber and shallow anterior chamber angle.Ultrasound biomicroscopy can confirm the situation of crystal-induced pupillary block.The study indicates that small incision phacoemulsification and foldable IOL implantation surgery in an early stage of senile cataract with anatomical factors of narrow angle can be effective in reducing intraocular pressure, preventing the occurrence of glaucoma caused by crystal expansion and pupillary block, which plays a role in the prevention and treatment in a certain extent.
