中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
3期
212-216
,共5页
陈婉%林浩添%吴昌睿%谢楚芳%黄祥坤%陈伟蓉
陳婉%林浩添%吳昌睿%謝楚芳%黃祥坤%陳偉蓉
진완%림호첨%오창예%사초방%황상곤%진위용
超声乳化白内障吸除术%葡萄膜脑膜脑炎综合征%贝赫切特综合征%前房%炎症
超聲乳化白內障吸除術%葡萄膜腦膜腦炎綜閤徵%貝赫切特綜閤徵%前房%炎癥
초성유화백내장흡제술%포도막뇌막뇌염종합정%패혁절특종합정%전방%염증
Phacoemulsification%Uveomeningoencephalitic syndrome%Beh(c)et syndrome%Anterior chamber%Inflammation
目的 探讨超声乳化白内障吸除联合囊袋内人工晶状体(IOL)植入术对Vogt-小柳原田综合征和Beh(c)et病并发性白内障患者前房炎症反应的影响.方法 队列研究.纳入2010年1月至2011年6月间于中山大学中山眼科中心住院行超声乳化白内障吸除联合囊袋内IOL植入术的Vogt-小柳原田综合征和Beh(c)et病并发性白内障患者17例(20只眼)作为实验组,所有患者炎症静止至少3个月；对照组选择同期行相同术式的年龄相关性白内障患者30例(40只眼).应用激光蛋白细胞检测仪(LFCM)定量检测其手术前后的前房闪辉值及炎症细胞计数.两组患者年龄、超声乳化能量及时间的比较采用独立样本t检验；同组间手术前后房水闪辉值及炎症细胞计数的比较采用配对￡检验；独立两样本间定量资料采用t检验.结果 纳入研究的并发性白内障患者包括Vogt-小柳原田综合征9例(1 1只眼)、Beh(c)et病8例(9只眼).实验组在术前及术后各时间点所测的房水闪辉值分别是(19.86±6.47)、(44.28±18.47)、(35.60±12.65)、(23.85±8.41)和(13.86±4.27) pc/ms,均明显高于对照组(5.61±3.04)、(13.63 ±2.58)、(8.55±2.75)、(5.27±2.56)和(4.05 ±2.31) pc/ms,差异具有统计学意义(t术前=4.643,P术前＜0.01；t1d=6.035,P1d＜0.Ol;t7d =3.595,P7d =0.001；t30d=4.658,P30d ＜0.01；t9od=3.308,P9od =0.002)；实验组在术后第30天下降至术前水平(t=0.320,P=0.753),而对照组则在术后第7天时下降至术前水平(t=0.454,P=0.653).实验组的房水炎症细胞计数在术后第1天、第7天时分别为(83.46±27.08)和(27.56±8.32)个/0.5 mm3,均高于术前(6.47±3.56)个/0.5 mm3(t1d =5.261,P1d ＜0.01;t7d=2.766,P7 d =0.012),第30天、术后第90天分别为(11.43±4.81)及(4.82±2.29)个/0.5 mm3,与术前相比较差异无统计学意义(t30d=2.348,P30d=0.042；t90d=1.376,P9od =0.186)；而对照组则于术后第7天下降至术前水平(t7d=2.464,P7d =0.018).结论 Vogt-小柳原田综合征和Beh(c)et病并发性白内障患者行超声乳化白内障吸除联合囊袋内IOL植入术后l周内前房炎症反应程度较重,活动性炎症反应在术后3个月时消退,而血-房水屏障功能的恢复则需更长时间.
目的 探討超聲乳化白內障吸除聯閤囊袋內人工晶狀體(IOL)植入術對Vogt-小柳原田綜閤徵和Beh(c)et病併髮性白內障患者前房炎癥反應的影響.方法 隊列研究.納入2010年1月至2011年6月間于中山大學中山眼科中心住院行超聲乳化白內障吸除聯閤囊袋內IOL植入術的Vogt-小柳原田綜閤徵和Beh(c)et病併髮性白內障患者17例(20隻眼)作為實驗組,所有患者炎癥靜止至少3箇月；對照組選擇同期行相同術式的年齡相關性白內障患者30例(40隻眼).應用激光蛋白細胞檢測儀(LFCM)定量檢測其手術前後的前房閃輝值及炎癥細胞計數.兩組患者年齡、超聲乳化能量及時間的比較採用獨立樣本t檢驗；同組間手術前後房水閃輝值及炎癥細胞計數的比較採用配對￡檢驗；獨立兩樣本間定量資料採用t檢驗.結果 納入研究的併髮性白內障患者包括Vogt-小柳原田綜閤徵9例(1 1隻眼)、Beh(c)et病8例(9隻眼).實驗組在術前及術後各時間點所測的房水閃輝值分彆是(19.86±6.47)、(44.28±18.47)、(35.60±12.65)、(23.85±8.41)和(13.86±4.27) pc/ms,均明顯高于對照組(5.61±3.04)、(13.63 ±2.58)、(8.55±2.75)、(5.27±2.56)和(4.05 ±2.31) pc/ms,差異具有統計學意義(t術前=4.643,P術前＜0.01；t1d=6.035,P1d＜0.Ol;t7d =3.595,P7d =0.001；t30d=4.658,P30d ＜0.01；t9od=3.308,P9od =0.002)；實驗組在術後第30天下降至術前水平(t=0.320,P=0.753),而對照組則在術後第7天時下降至術前水平(t=0.454,P=0.653).實驗組的房水炎癥細胞計數在術後第1天、第7天時分彆為(83.46±27.08)和(27.56±8.32)箇/0.5 mm3,均高于術前(6.47±3.56)箇/0.5 mm3(t1d =5.261,P1d ＜0.01;t7d=2.766,P7 d =0.012),第30天、術後第90天分彆為(11.43±4.81)及(4.82±2.29)箇/0.5 mm3,與術前相比較差異無統計學意義(t30d=2.348,P30d=0.042；t90d=1.376,P9od =0.186)；而對照組則于術後第7天下降至術前水平(t7d=2.464,P7d =0.018).結論 Vogt-小柳原田綜閤徵和Beh(c)et病併髮性白內障患者行超聲乳化白內障吸除聯閤囊袋內IOL植入術後l週內前房炎癥反應程度較重,活動性炎癥反應在術後3箇月時消退,而血-房水屏障功能的恢複則需更長時間.
목적 탐토초성유화백내장흡제연합낭대내인공정상체(IOL)식입술대Vogt-소류원전종합정화Beh(c)et병병발성백내장환자전방염증반응적영향.방법 대렬연구.납입2010년1월지2011년6월간우중산대학중산안과중심주원행초성유화백내장흡제연합낭대내IOL식입술적Vogt-소류원전종합정화Beh(c)et병병발성백내장환자17례(20지안)작위실험조,소유환자염증정지지소3개월；대조조선택동기행상동술식적년령상관성백내장환자30례(40지안).응용격광단백세포검측의(LFCM)정량검측기수술전후적전방섬휘치급염증세포계수.량조환자년령、초성유화능량급시간적비교채용독립양본t검험；동조간수술전후방수섬휘치급염증세포계수적비교채용배대￡검험；독립량양본간정량자료채용t검험.결과 납입연구적병발성백내장환자포괄Vogt-소류원전종합정9례(1 1지안)、Beh(c)et병8례(9지안).실험조재술전급술후각시간점소측적방수섬휘치분별시(19.86±6.47)、(44.28±18.47)、(35.60±12.65)、(23.85±8.41)화(13.86±4.27) pc/ms,균명현고우대조조(5.61±3.04)、(13.63 ±2.58)、(8.55±2.75)、(5.27±2.56)화(4.05 ±2.31) pc/ms,차이구유통계학의의(t술전=4.643,P술전＜0.01；t1d=6.035,P1d＜0.Ol;t7d =3.595,P7d =0.001；t30d=4.658,P30d ＜0.01；t9od=3.308,P9od =0.002)；실험조재술후제30천하강지술전수평(t=0.320,P=0.753),이대조조칙재술후제7천시하강지술전수평(t=0.454,P=0.653).실험조적방수염증세포계수재술후제1천、제7천시분별위(83.46±27.08)화(27.56±8.32)개/0.5 mm3,균고우술전(6.47±3.56)개/0.5 mm3(t1d =5.261,P1d ＜0.01;t7d=2.766,P7 d =0.012),제30천、술후제90천분별위(11.43±4.81)급(4.82±2.29)개/0.5 mm3,여술전상비교차이무통계학의의(t30d=2.348,P30d=0.042；t90d=1.376,P9od =0.186)；이대조조칙우술후제7천하강지술전수평(t7d=2.464,P7d =0.018).결론 Vogt-소류원전종합정화Beh(c)et병병발성백내장환자행초성유화백내장흡제연합낭대내IOL식입술후l주내전방염증반응정도교중,활동성염증반응재술후3개월시소퇴,이혈-방수병장공능적회복칙수경장시간.
Objective To investigate anterior chamber inflammation after phacoemulsification with intraocular lens (IOL) implantation in patients with Vogt-Koyanagi-Harada (VKH) syndrome or Beh(c)et's disease (BD).Methods Cohort study.Seventeen patients (20 eyes) with complicated cataracts and VKH syndrome or BD who underwent phacoemulsification with IOL implantation at Zhongshan Ophthalmic Center,Sun Yat-Sen University (SYSU) between January 2010 and June 2011 were included as the experimental group in this study.Cataract surgery was performed on these patients only when uveitis had been under control for more than three months.Thirty patients (40 eyes) with age-related cataracts who underwent phacoemulsification with IOL implantation in the same period were included as the control group.Quantitative measurements of anterior chamber aqueous flare and inflammatory cells were conducted preoperatively and postoperatively using a Laser Flare Cell Meter (LFCM).Independent t-test was used to compare patients' ages,and the energy and time of phacoemulsification between the two groups.The Student's t-test was used to assess the differences between paired data preoperatively and postoperatively.Independent t-test was also used to assess the quantitative data between groups.Results The study recruited 20 eyes in the experimental group and 40 eyes in the control group,including 11 eyes from 9 VKH patients and 9 eyes from 8 BD patients.The preoperative and postoperative flare values in the experimental group were (19.86 ±6.47),(44.28 ±18.47),(35.60± 12.65),(23.85 ±8.41),and (13.86 ± 4.27) pc/ms,respectively,which were statistically higher than that of the control group preoperatively,and on days 1,7,30,and 90 after surgery (tpre =4.643,Ppre ＜0.01; t1 =6.035,P1 ＜0.01; t7 =3.595,P7 =0.001 ; t30 =4.658,P30 ＜ 0.01 ; t90 =3.308,P90 =0.002).Aqueous flare in Group A and Group B declined to preoperative levels on day 30 (t =0.320,P =0.753) and day 7 (t =0.454,P =0.653).For the experimental group,the inflammatory cell count on day 1 and 7 was (83.46 ± 27.08) and (27.56 ± 8.32) cells/0.5 mm3,respectively,which was significantly higher than the preoperative level [(6.47 ± 3.56)cells/0.5 mm3,t1 =5.261,P1 ＜O.01; t7 =2.766,P7 =0.012].On days 30 and 90,the inflammatory cell count was (11.43 ± 4.81) and (4.82 ± 2.29) cells/0.5 mm3,respectively,and there was no statistically significant difference in the inflammatory cell count compared with the preoperative level (t30 =2.348,P30 =0.042; t90 =1.376,P90 =0.186).For the control group,inflammatory cell count reduced to pre-operative level on day 7 (t7 =2.464,P7 =0.018).Conclusions Anterior chamber inflammation reaches peak levels one week postoperatively in VKH and BD patients who receive phacoemulsification with IOL implantation.It takes three months for the inflammation to recede,and might take longer for complete restoration of the blood-aqueous barrier.
