中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2014年
11期
1025-1029
,共5页
特发性黄斑前膜/手术%白内障/手术%白内障超声乳化联合人工晶状体植入术%玻璃体切割术%屈光度%眼轴%近视漂移%生物测量
特髮性黃斑前膜/手術%白內障/手術%白內障超聲乳化聯閤人工晶狀體植入術%玻璃體切割術%屈光度%眼軸%近視漂移%生物測量
특발성황반전막/수술%백내장/수술%백내장초성유화연합인공정상체식입술%파리체절할술%굴광도%안축%근시표이%생물측량
Idiopathic macular epiretinal membrane/surgery%Cataract/surgery%Phacoemulsification with intraocular lens implantation%Vitrectomy%Refraction%Ocular axis%Myopic sift%Bio-measurement
背景 特发性黄斑前膜(IMEM)合并年龄相关性白内障(ARC)是老年人常见的眼部疾病,其主要治疗方法为白内障超声乳化人工晶状体(IOL)植入联合玻璃体切割术,而确定术前计算IOL屈光度时所用的IOL Master光学生物测量仪测量的眼轴长度是否受黄斑前膜的影响对术眼术后获得准确的屈光度至关重要.目的 了解IMEM患者行白内障联合玻璃体手术后屈光变化的特征.方法 采用前瞻性队列研究设计,纳入2010年9月至2011年8月在北京大学人民医院眼科中心确诊为IMEM合并ARC的患者42例42眼为IMEM合并ARC组,行白内障超声乳化IOL植入术联合玻璃体切割术,同期纳入单纯ARC患者47例47眼为单纯ARC组,行白内障超声乳化IOL植入术.术前应用IOL Master光学生物测量仪测量术眼眼轴长度及角膜曲率,应用SRK-T公式计算出IOL植入后的预期屈光度.术后1个月、3个月进行眼科常规检查和医学验光,计算其等效球镜度数作为术后实际屈光度,并对术后实际屈光度与预期屈光度进行对比分析.对两个组间术眼手术前后屈光度的误差进行比较,对IMEM合并ARC患者术后屈光度误差与黄斑中心凹厚度变化的关系进行分析.结果 术前两个组间患者年龄、眼轴长度和角膜曲率的差异均无统计学意义(P=0.863、0.704、0.770).IMEM合并ARC组和单纯ARC组患者术后3个月视力较术前均明显改善,差异均有统计学意义(P=0.001、0.000).IMEM合并ARC组患者术后1个月和3个月的实际屈光度绝对值均明显高于术前预期屈光度绝对值,差异均有统计学意义(P＜0.001);单纯ARC组患者术后1个月和3个月实际屈光度绝对值明显高于术前预期屈光度绝对值,差异均有统计学意义(p＜0.O01);但IMEM合并ARC组与单纯ARC组间手术前后的屈光度值差异无统计学意义(F分组=0.417,P=0.520).IMEM合并ARC组术眼术后1个月、3个月的屈光度误差分别为(-0.727±0.666)D和(-0.628±0.627)D,单纯ARC组分别为(-0.664±0.644)D和(-0.642±0.550)D,差异均无统计学意义(F分组=0.036,P=0.849;F时间=1.523,P=0.221);IMEM合并ARC组术前黄斑中心凹厚度为(474.89±135.76) μm,术后1个月黄斑中心凹厚度变化值为(-83.84±91.12)μm,术后3个月为(-158.53±113.03)μm.IMEM合并ARC组术眼术后1个月和3个月屈光度误差与黄斑中心凹厚度变化间均无明显相关性(r=0.200,P=0.229;r=0.065,P=O.698).结论 IMEM合并ARC患者行白内障超声乳化IOL植入联合玻璃体手术后呈现的近视漂移现象和程度与单纯ARC患者术后相似,证实IOLMaster光学生物测量仪测量的眼轴长度不受黄斑前膜的影响.
揹景 特髮性黃斑前膜(IMEM)閤併年齡相關性白內障(ARC)是老年人常見的眼部疾病,其主要治療方法為白內障超聲乳化人工晶狀體(IOL)植入聯閤玻璃體切割術,而確定術前計算IOL屈光度時所用的IOL Master光學生物測量儀測量的眼軸長度是否受黃斑前膜的影響對術眼術後穫得準確的屈光度至關重要.目的 瞭解IMEM患者行白內障聯閤玻璃體手術後屈光變化的特徵.方法 採用前瞻性隊列研究設計,納入2010年9月至2011年8月在北京大學人民醫院眼科中心確診為IMEM閤併ARC的患者42例42眼為IMEM閤併ARC組,行白內障超聲乳化IOL植入術聯閤玻璃體切割術,同期納入單純ARC患者47例47眼為單純ARC組,行白內障超聲乳化IOL植入術.術前應用IOL Master光學生物測量儀測量術眼眼軸長度及角膜麯率,應用SRK-T公式計算齣IOL植入後的預期屈光度.術後1箇月、3箇月進行眼科常規檢查和醫學驗光,計算其等效毬鏡度數作為術後實際屈光度,併對術後實際屈光度與預期屈光度進行對比分析.對兩箇組間術眼手術前後屈光度的誤差進行比較,對IMEM閤併ARC患者術後屈光度誤差與黃斑中心凹厚度變化的關繫進行分析.結果 術前兩箇組間患者年齡、眼軸長度和角膜麯率的差異均無統計學意義(P=0.863、0.704、0.770).IMEM閤併ARC組和單純ARC組患者術後3箇月視力較術前均明顯改善,差異均有統計學意義(P=0.001、0.000).IMEM閤併ARC組患者術後1箇月和3箇月的實際屈光度絕對值均明顯高于術前預期屈光度絕對值,差異均有統計學意義(P＜0.001);單純ARC組患者術後1箇月和3箇月實際屈光度絕對值明顯高于術前預期屈光度絕對值,差異均有統計學意義(p＜0.O01);但IMEM閤併ARC組與單純ARC組間手術前後的屈光度值差異無統計學意義(F分組=0.417,P=0.520).IMEM閤併ARC組術眼術後1箇月、3箇月的屈光度誤差分彆為(-0.727±0.666)D和(-0.628±0.627)D,單純ARC組分彆為(-0.664±0.644)D和(-0.642±0.550)D,差異均無統計學意義(F分組=0.036,P=0.849;F時間=1.523,P=0.221);IMEM閤併ARC組術前黃斑中心凹厚度為(474.89±135.76) μm,術後1箇月黃斑中心凹厚度變化值為(-83.84±91.12)μm,術後3箇月為(-158.53±113.03)μm.IMEM閤併ARC組術眼術後1箇月和3箇月屈光度誤差與黃斑中心凹厚度變化間均無明顯相關性(r=0.200,P=0.229;r=0.065,P=O.698).結論 IMEM閤併ARC患者行白內障超聲乳化IOL植入聯閤玻璃體手術後呈現的近視漂移現象和程度與單純ARC患者術後相似,證實IOLMaster光學生物測量儀測量的眼軸長度不受黃斑前膜的影響.
배경 특발성황반전막(IMEM)합병년령상관성백내장(ARC)시노년인상견적안부질병,기주요치료방법위백내장초성유화인공정상체(IOL)식입연합파리체절할술,이학정술전계산IOL굴광도시소용적IOL Master광학생물측량의측량적안축장도시부수황반전막적영향대술안술후획득준학적굴광도지관중요.목적 료해IMEM환자행백내장연합파리체수술후굴광변화적특정.방법 채용전첨성대렬연구설계,납입2010년9월지2011년8월재북경대학인민의원안과중심학진위IMEM합병ARC적환자42례42안위IMEM합병ARC조,행백내장초성유화IOL식입술연합파리체절할술,동기납입단순ARC환자47례47안위단순ARC조,행백내장초성유화IOL식입술.술전응용IOL Master광학생물측량의측량술안안축장도급각막곡솔,응용SRK-T공식계산출IOL식입후적예기굴광도.술후1개월、3개월진행안과상규검사화의학험광,계산기등효구경도수작위술후실제굴광도,병대술후실제굴광도여예기굴광도진행대비분석.대량개조간술안수술전후굴광도적오차진행비교,대IMEM합병ARC환자술후굴광도오차여황반중심요후도변화적관계진행분석.결과 술전량개조간환자년령、안축장도화각막곡솔적차이균무통계학의의(P=0.863、0.704、0.770).IMEM합병ARC조화단순ARC조환자술후3개월시력교술전균명현개선,차이균유통계학의의(P=0.001、0.000).IMEM합병ARC조환자술후1개월화3개월적실제굴광도절대치균명현고우술전예기굴광도절대치,차이균유통계학의의(P＜0.001);단순ARC조환자술후1개월화3개월실제굴광도절대치명현고우술전예기굴광도절대치,차이균유통계학의의(p＜0.O01);단IMEM합병ARC조여단순ARC조간수술전후적굴광도치차이무통계학의의(F분조=0.417,P=0.520).IMEM합병ARC조술안술후1개월、3개월적굴광도오차분별위(-0.727±0.666)D화(-0.628±0.627)D,단순ARC조분별위(-0.664±0.644)D화(-0.642±0.550)D,차이균무통계학의의(F분조=0.036,P=0.849;F시간=1.523,P=0.221);IMEM합병ARC조술전황반중심요후도위(474.89±135.76) μm,술후1개월황반중심요후도변화치위(-83.84±91.12)μm,술후3개월위(-158.53±113.03)μm.IMEM합병ARC조술안술후1개월화3개월굴광도오차여황반중심요후도변화간균무명현상관성(r=0.200,P=0.229;r=0.065,P=O.698).결론 IMEM합병ARC환자행백내장초성유화IOL식입연합파리체수술후정현적근시표이현상화정도여단순ARC환자술후상사,증실IOLMaster광학생물측량의측량적안축장도불수황반전막적영향.
Background Idiopathic macular epiretinal membrane (IMEM) combined with age-related cataract (ARC)is a common eye disease and the primary managing approach is the combination of phacoemulsification,intraocular lens (IOL) implantation and vitrectomy.However,whether the ocular length measured by IOL Master is accurate for the calculation of IOL refraction in the eye with IMEM remains unclear.Objective The aim of this study was to evaluate the refractive outcomes of combination surgery of phacoemulsification,IOL implantation and vitrectomy in IMEM eyes.Methods A prospective cohort study was designed.Forty-two eyes of 42 patients with IMEM combined with ARC (IMEM+ARC group) were enrolled in Peking University People's Hospital and the combination of phacoemulsification,IOL implantation and vitrectomy was performed from September 2010 to August 2011,and 47 eyes of 47 patients with ARC were included for the phacoemulsification combined with IOL implantation in the corresponding period (ARC group) under the approval of Ethic Committee of Peking University People's Hospital and informed consent of the patients.Ocular length and corneal curvature were measured using IOL Master,and the expected IOL diopter was calculated with SRK-T formula.Regular eye examination and medical optometry were performed 1 month and 3 months after operation to obtain the actual diopter and the refractive error.The outcomes were compared between the two groups.The correlations of refractive error with change of fovea thickness were evaluated after operation in the IMEM+ARC group.Results There were no statistically significant differences in the age,ocular length and corneal curvature between the two groups before operation (P =0.863,0.704,0.770).The visual acuity was improved 3 months after operation in comparison with before operation in both groups (P=0.001,0.000).The negative diopters were obviously higher 1 month and 3 months after operation than those before operation in both groups (all at P＜0.001),but no significant difference was seen between the IMEM+ ARC group and ARC group (Fgroup =0.417,P =0.520).The diopter deviations 1 month and 3 months after operation were (-0.727±0.666)D and (-0.628±0.627)D in the IMEM+ARC group,and those in the ARC group were (-0.664±0.644) D and (-0.642±0.550) D,showing insignificant differences between the two groups (Fgroup =0.036,P =0.849 ; Ftime =1.523,P =0.221).In IMEM + ARC group,the macular fovea thickness was (474.89 ± 135.76)μm in preoperation,and the shift values of macular fovea thickness were (-83.84 ±91.12)μm and (-158.53±113.03) μm in postoperative 1 month and 3 months.No positive correlations were presented between the diopter deviations and change of fovea thickness 1 month and 3 months after operation in the IMEM+ARC group (r=0.200,P =0.229 ; r =0.065,P =0.698).Conclusions Myopia shift after operation is similar in the IMEM combined with ARC patients to the only ARC patients,suggesting that the ocular length and corneal curvature measured by IOL Master is not affected by epiretinal membrane.
