中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
3期
235-241
,共7页
有晶状体眼人工晶状体植入术%角膜%选择行为%显微镜检查,声学%回顾性研究
有晶狀體眼人工晶狀體植入術%角膜%選擇行為%顯微鏡檢查,聲學%迴顧性研究
유정상체안인공정상체식입술%각막%선택행위%현미경검사,성학%회고성연구
Phakic intraocular lenses%Cornea%Choice behavior%Microscopy,acoustic%Retrospective studies
目的 评价根据角膜水平直径选择有晶状体眼后房型人工晶状体(ICL)长度的临床意义及其有效性、安全性.方法 回顾性系列病例研究.2005年11月15日至2011年1月15日间在浙江大学医学院附属第一医院眼科行有晶状体眼ICL植入术矫正高度近视者32例(64只眼),术前根据OrbscanⅡ测量的角膜水平直径选择ICL长度,行ICL植入术,术后1d、1周、1、3、6、12个月及之后每半年进行一次随访,内容包括裸眼视力、最佳矫正视力、屈光度数、眼压、角膜内皮计数、裂隙灯检查(观察晶状体透明度、眼内色素播散情况)、IOL Master检查(测量前房深度、角膜水平直径)、超声活体显微镜检查(测量角膜内表面与自身晶状体之间的距离、角膜内表面与ICL之间的距离、ICL中央部与自身晶状体之间的距离、ICL周边部与自身晶状体之间的距离、ICL倾斜度、睫状沟间距、小梁虹膜夹角、房角开放距离500、虹膜-ICL接触距离),采用配对￡检验、相关性分析及多因素回归分析等方法对所有患者术后1年时与术前的各项观察指标进行统计学分析.结果 术后未发现任何术眼出现晶状体前囊膜下混浊,也未发现角膜内表面或自身晶状体前囊膜色素沉着,而在ICL前表面和后表面有Ⅰ～Ⅱ级的色素沉着,两者程度上的差异无统计学意义(x2 =2.24,P=0.13).术前眼压为(15.67±3.23)mm Hg(1 mm Hg=0.133 kPa),术后1年时眼压为(15.78±3.23) mm Hg,两者间差异无统计学意义(=0.24,P=0.38).术后1年中央角膜内表面与晶状体之间的距离为(2.97±0.25)mm,中央角膜内表面与ICL之间的距离为(2.24 ±0.27) mm,两者差异有统计学意义(t=15.77,P＜0.01).ICL倾斜度,术后1年为0°～5°,平均为1.20°±1.05°.小梁虹膜夹角＞30°者占29.1％,21°～30°者占50.0％,11°～20°者占11.6％,≤10°者占9.3％.房角开放距离500(AOD500)为(0.32±0.15)mm.虹膜-ICL接触距离为(0.85 ±0.46) mm.ICL中央拱高(ICL中央部与自身晶状体之间的距离)平均为(0.47±0.25)mm,与角膜水平直径的相关系数r=0.11,与睫状沟间距的相关系数r=0.16,与前房深度的相关系数r=0.04,与ICL长度的相关系数r=0.19,均无统计学意义(P＞0.05).ICL周边拱高(ICL周边部与自身晶状体之间的距离)为0～1.23 mm,平均为(0.25±0.20) mm.结论 根据角膜水平直径选择的ICL,其长度适宜,术后并发症少,ICL拱高理想,为ICL植入术良好的安全性、有效性和可预测性提供了有力保障.
目的 評價根據角膜水平直徑選擇有晶狀體眼後房型人工晶狀體(ICL)長度的臨床意義及其有效性、安全性.方法 迴顧性繫列病例研究.2005年11月15日至2011年1月15日間在浙江大學醫學院附屬第一醫院眼科行有晶狀體眼ICL植入術矯正高度近視者32例(64隻眼),術前根據OrbscanⅡ測量的角膜水平直徑選擇ICL長度,行ICL植入術,術後1d、1週、1、3、6、12箇月及之後每半年進行一次隨訪,內容包括裸眼視力、最佳矯正視力、屈光度數、眼壓、角膜內皮計數、裂隙燈檢查(觀察晶狀體透明度、眼內色素播散情況)、IOL Master檢查(測量前房深度、角膜水平直徑)、超聲活體顯微鏡檢查(測量角膜內錶麵與自身晶狀體之間的距離、角膜內錶麵與ICL之間的距離、ICL中央部與自身晶狀體之間的距離、ICL週邊部與自身晶狀體之間的距離、ICL傾斜度、睫狀溝間距、小樑虹膜夾角、房角開放距離500、虹膜-ICL接觸距離),採用配對￡檢驗、相關性分析及多因素迴歸分析等方法對所有患者術後1年時與術前的各項觀察指標進行統計學分析.結果 術後未髮現任何術眼齣現晶狀體前囊膜下混濁,也未髮現角膜內錶麵或自身晶狀體前囊膜色素沉著,而在ICL前錶麵和後錶麵有Ⅰ～Ⅱ級的色素沉著,兩者程度上的差異無統計學意義(x2 =2.24,P=0.13).術前眼壓為(15.67±3.23)mm Hg(1 mm Hg=0.133 kPa),術後1年時眼壓為(15.78±3.23) mm Hg,兩者間差異無統計學意義(=0.24,P=0.38).術後1年中央角膜內錶麵與晶狀體之間的距離為(2.97±0.25)mm,中央角膜內錶麵與ICL之間的距離為(2.24 ±0.27) mm,兩者差異有統計學意義(t=15.77,P＜0.01).ICL傾斜度,術後1年為0°～5°,平均為1.20°±1.05°.小樑虹膜夾角＞30°者佔29.1％,21°～30°者佔50.0％,11°～20°者佔11.6％,≤10°者佔9.3％.房角開放距離500(AOD500)為(0.32±0.15)mm.虹膜-ICL接觸距離為(0.85 ±0.46) mm.ICL中央拱高(ICL中央部與自身晶狀體之間的距離)平均為(0.47±0.25)mm,與角膜水平直徑的相關繫數r=0.11,與睫狀溝間距的相關繫數r=0.16,與前房深度的相關繫數r=0.04,與ICL長度的相關繫數r=0.19,均無統計學意義(P＞0.05).ICL週邊拱高(ICL週邊部與自身晶狀體之間的距離)為0～1.23 mm,平均為(0.25±0.20) mm.結論 根據角膜水平直徑選擇的ICL,其長度適宜,術後併髮癥少,ICL拱高理想,為ICL植入術良好的安全性、有效性和可預測性提供瞭有力保障.
목적 평개근거각막수평직경선택유정상체안후방형인공정상체(ICL)장도적림상의의급기유효성、안전성.방법 회고성계렬병례연구.2005년11월15일지2011년1월15일간재절강대학의학원부속제일의원안과행유정상체안ICL식입술교정고도근시자32례(64지안),술전근거OrbscanⅡ측량적각막수평직경선택ICL장도,행ICL식입술,술후1d、1주、1、3、6、12개월급지후매반년진행일차수방,내용포괄라안시력、최가교정시력、굴광도수、안압、각막내피계수、렬극등검사(관찰정상체투명도、안내색소파산정황)、IOL Master검사(측량전방심도、각막수평직경)、초성활체현미경검사(측량각막내표면여자신정상체지간적거리、각막내표면여ICL지간적거리、ICL중앙부여자신정상체지간적거리、ICL주변부여자신정상체지간적거리、ICL경사도、첩상구간거、소량홍막협각、방각개방거리500、홍막-ICL접촉거리),채용배대￡검험、상관성분석급다인소회귀분석등방법대소유환자술후1년시여술전적각항관찰지표진행통계학분석.결과 술후미발현임하술안출현정상체전낭막하혼탁,야미발현각막내표면혹자신정상체전낭막색소침착,이재ICL전표면화후표면유Ⅰ～Ⅱ급적색소침착,량자정도상적차이무통계학의의(x2 =2.24,P=0.13).술전안압위(15.67±3.23)mm Hg(1 mm Hg=0.133 kPa),술후1년시안압위(15.78±3.23) mm Hg,량자간차이무통계학의의(=0.24,P=0.38).술후1년중앙각막내표면여정상체지간적거리위(2.97±0.25)mm,중앙각막내표면여ICL지간적거리위(2.24 ±0.27) mm,량자차이유통계학의의(t=15.77,P＜0.01).ICL경사도,술후1년위0°～5°,평균위1.20°±1.05°.소량홍막협각＞30°자점29.1％,21°～30°자점50.0％,11°～20°자점11.6％,≤10°자점9.3％.방각개방거리500(AOD500)위(0.32±0.15)mm.홍막-ICL접촉거리위(0.85 ±0.46) mm.ICL중앙공고(ICL중앙부여자신정상체지간적거리)평균위(0.47±0.25)mm,여각막수평직경적상관계수r=0.11,여첩상구간거적상관계수r=0.16,여전방심도적상관계수r=0.04,여ICL장도적상관계수r=0.19,균무통계학의의(P＞0.05).ICL주변공고(ICL주변부여자신정상체지간적거리)위0～1.23 mm,평균위(0.25±0.20) mm.결론 근거각막수평직경선택적ICL,기장도괄의,술후병발증소,ICL공고이상,위ICL식입술량호적안전성、유효성화가예측성제공료유력보장.
Objective To evaluate the efficacy,safety and clinical value of calculating the posterior chamber phakic intraocular lens (ICL) length according to the corneal horizontal diameter.Methods This was a retrospective study.A Staar Visian implantable contact lens (ICL) was implanted in 32 patients (64 eyes) with high myopia in the Department of Ophthalmology,the First Affiliated Hospital,College of Medicine,Zhejiang University between November 15,2005 and January 15,2011.The lens length was calculated according to the corneal horizontal diameter measured by Orbscan Ⅱ.Patients were followed up postoperatively at 1 day,1 week,1,3,6 and 12 months and every 6 months thereafter.The evaluations included visual acuity,manifest refraction,applanation tonometry,endothelial cell count,slit-lamp microscopy to detect cataract,and UBM to assess the degree of ICL tilt and distances between the corneal endothelium,the ICL,and the crystalline lens.All of the preoperative and 12-month follow-up observations were analyzed using SPSS 16.0 software.Results No anterior subcapsular cataracts were found in any of the eyes after surgery.Pigmentary dispersion was observed on the anterior and posterior surface of the ICL,but the difference was not statistically significant (x2 =2.24,P =0.13).The intraocular pressure changed from (15.67 ± 3.23) mm Hg(1 mm Hg =0.133 kPa) to (15.78 ± 3.23)mm Hg,but the difference was not significant (t =0.24,P =0.38).The corneal endothelium-lens (central section) distance measured by UBM postoperatively was(2.97 ± 0.25) mm and the corneal endothelium-ICL (central section) distance was (2.24 ±0.27) mm; the difference between them was statistically significant (t =15.77,P ＜ 0.01).The degree of ICL tilt measured by UBM was 1.20° ± 1.05 °.The percentage of eyes with a trabecular-iris angle (TIA) greater than 30°,between 21 ° and 30°,between 11 °and 20°,and smaller than 10° were 29.1％,50.0％,11.6％,and 9.3％,respectively.The angle opening distance at 500 micron (AOD500) measured by UBM postoperatively was (0.32 ± 0.15)mm.The contact distance between the iris and the ICL measured by UBM postoperatively was (0.85 ± 0.46) mm and the ICL-lens central distance was (0.47 ± 0.25) mm.The Pearson's correlation coefficients between the ICL-lens central distance and the corneal horizontal diameter,sulcus diameter,anterior chamber depth (ACD) and ICL length were 0.11,0.16,0.04 and 0.19,respectively; none were statistically significant.The ICL-lens peripheral distance measured by UBM postoperatively was (0.25 ± 0.20) mm.Conclusion Selecting the length of the ICL according to the corneal horizontal diameter is appropriate,and assures the safety,effectiveness and predictability of ICL implantation.
