中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
4期
377-380
,共4页
李姝燕%张敏%杜驰%温秀媚
李姝燕%張敏%杜馳%溫秀媚
리주연%장민%두치%온수미
后发性白内障%可调节人工晶状体%Nd∶YAG激光%后囊膜切开术
後髮性白內障%可調節人工晶狀體%Nd∶YAG激光%後囊膜切開術
후발성백내장%가조절인공정상체%Nd∶YAG격광%후낭막절개술
Posterior capsular opacification%Accommodating intraocular lens%Nd∶ YAG laser%Capsulotomy
背景 后发性白内障的发生使1CU可调节人工晶状体(1CU AIOL)的拟调节力及远近视功能明显下降,影响其远期临床效果.目前国内外关于后发性白内障对IOL眼内移动度的影响及Nd∶YAG激光后囊膜切开术后是否可恢复IOL眼内移动度的研究报道较少. 目的 探讨后发性白内障及Nd∶YAG激光后囊膜切开术对1CU AIOL眼内移动度的影响.方法 采用系列病例观察试验设计.收集因单纯性白内障行白内障超声乳化摘出术联合1CU AIOL植入术后发生后发性白内障者20例24眼,分别于IOL植入术后3个月、Nd:YAG激光后囊膜切开术前1d、Nd∶YAG激光后囊膜切开术后3个月进行随访观察,检测术眼最佳矫正远视力下的近视力(DCNVA),并用IOL Master检测10 g/L匹罗卡品滴眼液点眼前及点眼后的前房深度,计算其差值作为IOL的眼内移动度.比较上述3个时间点IOL的眼内移动度变化,评价后发性白内障及激光治疗对1CU AIOL眼内移动的影响. 结果 1CU AIOL植入术后3个月IOL的眼内移动度为(0.44±0.21)mm,发生后发性白内障后,术眼行Nd:YAG激光后囊膜切开术前1 d IOL的眼内移动度为(0.27±0.11)mm,Nd:YAG激光后囊膜切开术后3个月IOL的眼内移动度为(0.34±0.10)mm,3个时间点间IOL的眼内移动度差异有统计学意义(F=7.180,P=0.001),与IOL植入术后3个月比较,Nd∶YAG激光后囊膜切开术前1d IOL的眼内移动度明显下降,差异有统计学意义(P=0.006);与后囊膜切开术前1d相比,Nd∶YAG激光后囊膜切开术后3个月IOL的眼内移动度略有增加,但差异无统计学意义(P=0.059).1CU AIOL植入术后3个月术眼DCNVA为(3.1±0.9)J,Nd∶YAG激光后囊膜切开术前1d为(6.2±0.8)J,Nd∶YAG激光后囊膜切开术后3个月为(3.4±0.7)J,3个时间点间的差异有统计学意义(F=110.270,P=0.000),其中Nd∶YAG激光后囊膜切开术前1d术眼DCNVA明显低于IOL植入术后3个月,差异有统计学意义(P＜0.05),与后囊膜切开术前1d相比,Nd∶YAG激光后囊膜切开术后3个月术眼DCNVA明显增加,差异有统计学意义(P＜0.05).IOL植入术后3个月、Nd∶YAG激光后囊膜切开术前1d、Nd∶YAG激光后囊膜切开术后3个月DCNVA与1CU AIOL的眼内移动度均无显著的相关性(r1=-0.150,P1=0.486;r2 =-0.320,P2=0.122:r3=-0.100,P3=0.633). 结论 后发性白内障使1CU AIOL的眼内移动度明显下降,Nd∶YAG激光后囊膜切开术对IOL的移动度并无明显影响,但术后术眼仍可恢复较好的视近功能,可能与多种因素产生的拟调节有关.
揹景 後髮性白內障的髮生使1CU可調節人工晶狀體(1CU AIOL)的擬調節力及遠近視功能明顯下降,影響其遠期臨床效果.目前國內外關于後髮性白內障對IOL眼內移動度的影響及Nd∶YAG激光後囊膜切開術後是否可恢複IOL眼內移動度的研究報道較少. 目的 探討後髮性白內障及Nd∶YAG激光後囊膜切開術對1CU AIOL眼內移動度的影響.方法 採用繫列病例觀察試驗設計.收集因單純性白內障行白內障超聲乳化摘齣術聯閤1CU AIOL植入術後髮生後髮性白內障者20例24眼,分彆于IOL植入術後3箇月、Nd:YAG激光後囊膜切開術前1d、Nd∶YAG激光後囊膜切開術後3箇月進行隨訪觀察,檢測術眼最佳矯正遠視力下的近視力(DCNVA),併用IOL Master檢測10 g/L匹囉卡品滴眼液點眼前及點眼後的前房深度,計算其差值作為IOL的眼內移動度.比較上述3箇時間點IOL的眼內移動度變化,評價後髮性白內障及激光治療對1CU AIOL眼內移動的影響. 結果 1CU AIOL植入術後3箇月IOL的眼內移動度為(0.44±0.21)mm,髮生後髮性白內障後,術眼行Nd:YAG激光後囊膜切開術前1 d IOL的眼內移動度為(0.27±0.11)mm,Nd:YAG激光後囊膜切開術後3箇月IOL的眼內移動度為(0.34±0.10)mm,3箇時間點間IOL的眼內移動度差異有統計學意義(F=7.180,P=0.001),與IOL植入術後3箇月比較,Nd∶YAG激光後囊膜切開術前1d IOL的眼內移動度明顯下降,差異有統計學意義(P=0.006);與後囊膜切開術前1d相比,Nd∶YAG激光後囊膜切開術後3箇月IOL的眼內移動度略有增加,但差異無統計學意義(P=0.059).1CU AIOL植入術後3箇月術眼DCNVA為(3.1±0.9)J,Nd∶YAG激光後囊膜切開術前1d為(6.2±0.8)J,Nd∶YAG激光後囊膜切開術後3箇月為(3.4±0.7)J,3箇時間點間的差異有統計學意義(F=110.270,P=0.000),其中Nd∶YAG激光後囊膜切開術前1d術眼DCNVA明顯低于IOL植入術後3箇月,差異有統計學意義(P＜0.05),與後囊膜切開術前1d相比,Nd∶YAG激光後囊膜切開術後3箇月術眼DCNVA明顯增加,差異有統計學意義(P＜0.05).IOL植入術後3箇月、Nd∶YAG激光後囊膜切開術前1d、Nd∶YAG激光後囊膜切開術後3箇月DCNVA與1CU AIOL的眼內移動度均無顯著的相關性(r1=-0.150,P1=0.486;r2 =-0.320,P2=0.122:r3=-0.100,P3=0.633). 結論 後髮性白內障使1CU AIOL的眼內移動度明顯下降,Nd∶YAG激光後囊膜切開術對IOL的移動度併無明顯影響,但術後術眼仍可恢複較好的視近功能,可能與多種因素產生的擬調節有關.
배경 후발성백내장적발생사1CU가조절인공정상체(1CU AIOL)적의조절력급원근시공능명현하강,영향기원기림상효과.목전국내외관우후발성백내장대IOL안내이동도적영향급Nd∶YAG격광후낭막절개술후시부가회복IOL안내이동도적연구보도교소. 목적 탐토후발성백내장급Nd∶YAG격광후낭막절개술대1CU AIOL안내이동도적영향.방법 채용계렬병례관찰시험설계.수집인단순성백내장행백내장초성유화적출술연합1CU AIOL식입술후발생후발성백내장자20례24안,분별우IOL식입술후3개월、Nd:YAG격광후낭막절개술전1d、Nd∶YAG격광후낭막절개술후3개월진행수방관찰,검측술안최가교정원시력하적근시력(DCNVA),병용IOL Master검측10 g/L필라잡품적안액점안전급점안후적전방심도,계산기차치작위IOL적안내이동도.비교상술3개시간점IOL적안내이동도변화,평개후발성백내장급격광치료대1CU AIOL안내이동적영향. 결과 1CU AIOL식입술후3개월IOL적안내이동도위(0.44±0.21)mm,발생후발성백내장후,술안행Nd:YAG격광후낭막절개술전1 d IOL적안내이동도위(0.27±0.11)mm,Nd:YAG격광후낭막절개술후3개월IOL적안내이동도위(0.34±0.10)mm,3개시간점간IOL적안내이동도차이유통계학의의(F=7.180,P=0.001),여IOL식입술후3개월비교,Nd∶YAG격광후낭막절개술전1d IOL적안내이동도명현하강,차이유통계학의의(P=0.006);여후낭막절개술전1d상비,Nd∶YAG격광후낭막절개술후3개월IOL적안내이동도략유증가,단차이무통계학의의(P=0.059).1CU AIOL식입술후3개월술안DCNVA위(3.1±0.9)J,Nd∶YAG격광후낭막절개술전1d위(6.2±0.8)J,Nd∶YAG격광후낭막절개술후3개월위(3.4±0.7)J,3개시간점간적차이유통계학의의(F=110.270,P=0.000),기중Nd∶YAG격광후낭막절개술전1d술안DCNVA명현저우IOL식입술후3개월,차이유통계학의의(P＜0.05),여후낭막절개술전1d상비,Nd∶YAG격광후낭막절개술후3개월술안DCNVA명현증가,차이유통계학의의(P＜0.05).IOL식입술후3개월、Nd∶YAG격광후낭막절개술전1d、Nd∶YAG격광후낭막절개술후3개월DCNVA여1CU AIOL적안내이동도균무현저적상관성(r1=-0.150,P1=0.486;r2 =-0.320,P2=0.122:r3=-0.100,P3=0.633). 결론 후발성백내장사1CU AIOL적안내이동도명현하강,Nd∶YAG격광후낭막절개술대IOL적이동도병무명현영향,단술후술안잉가회복교호적시근공능,가능여다충인소산생적의조절유관.
Background Posterior capsular opacification (PCO)affects the pseudoaccommodation of 1CU accommodative intraocular lens (1CU AIOL).At present,few studies on the effect of PCO and Nd∶ YAG laser capsulotomy on intraocular shifting of 1CU AIOL are published.Objective The present study was to evaluate the effect of PCO and Nd∶YAG laser capsulotomy on the shifting of 1CU AIOL.Methods A respective serial caseobservational study was designed.Written informed consent was obtained from each patient prior to this study.Twentyfour eyes of 20 patients with PCO after phacoemulsification and implantation of 1CU AIOL were included in this study.Ocular examination was performed 3 months after IOL implantation,1 day before Nd:YAG laser capsulotomy and 3 months after Nd∶YAG laser capsulotomy to evaluate the distance corrected near visual acuity(DCNVA).The difference in the anterior chamber depths before and after administering 1％ pilocarpine topical eye drops was measured with the IOLMaster to determine the intraocular shifts of the IOL.The extent of IOL shifting was compared among 3 time points to assess the factors influencing IOL accommodation after 1CU AIOL implantation.Results The shifting amplitude of 1CU AIOL was(0.44±0.21)mm 3 months after implantation of 1CU AIOL,(0.27±0.11)mm 1 day before Nd ∶ YAG laser capsulotomy,and (0.34±0.10) mm 3 months after Nd ∶ YAG laser capsulotomy,showing a significant difference among them(F=7.180,P=0.001).The shifting amplitude of 1CU AIOL significantly declined 1 day before Nd∶YAG laser capsulotomy in comparison with 3 months after implantation of 1 CU AIOL(P =0.006).The shifting amplitude 3 months after Nd∶YAG laser capsulotomy increased slightly in comparison with 1 day before Nd∶YAG laser capsulotomy(P=0.059).DCNVA was(3.1±0.9)J 3 months after implantation of 1CU AIOL,(6.2±0.8) J 1 day before Nd ∶ YAG laser capsulotomy and(3.4±0.7) J 3 months after Nd ∶ YAG laser capsulotomy,with a significant difference among them (F =110.270,P =0.000).DCNVA was lower 1 day before Nd∶ YAG laser capsulotomy than 3 months after implantation of 1CU AIOL(P＜0.05).However,DCNVA was higher 3 months after Nd∶YAG laser capsulotomy than that of 1 day before Nd∶YAG laser capsulotomy (P＜0.05).There was no significant correlations between DCNVA and IOL movement 3 months after IOL implantation,1 day before Nd∶ YAG laser capsulotomy and 3 months after Nd ∶ YAG laser capsulotomy (r1 =-0.150,P1 =0.486,r2 =-0.320,P2 =0.122,r3 =-0.100,P3 =0.633).Conclusions The shifting amplitude of 1CU AIOL markedly declines due to PCO.No clinically significant influence of Nd ∶ YAG laser capsulotomy on the shifting amplitude of 1 CU AIOL is found.DCNVA can improve after Nd∶YAG laser capsulotomy.Multiple inter-related factors concerning pseudophakic accommodation may influence DCNVA.
