白内障超声乳化联合人工晶体植入术后眼内生物测量指标变化及人工晶体设计的临床研究

发布时间：2018-01-01 00:18

本文关键词：白内障超声乳化联合人工晶体植入术后眼内生物测量指标变化及人工晶体设计的临床研究　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究拟通过测量不同设计类型的人工晶体进行白内障超声乳化联合人工晶体植入术后早期眼内生物测量指标及眼压的改变,探讨白内障超声乳化联合人工晶体植入术后眼内生物测量指标变化情况,以及何种设计类型的人工晶体更利于降低手术对眼前节解剖的影响、减少术后玻璃体前移,进而提高患者的舒适度减少术后并发症的发生。材料和方法:回顾性病例研究。本研究收集2016年3月至2017年1月就诊于大连医科大学附属第二医院眼科行囊内白内障超声乳化吸出联合人工晶体植入术100例(100只眼)患者资料。病人按照人工晶体类型分为4组,每组25例。组1植入Rayner人工晶体,组2植入Hoya人工晶体,组3植入Bigbag人工晶体,组4植入ReSTOR人工晶体(25例)。为了减少组间晶体厚度的差异,纳入本研究患者的晶体厚度均介于4.0-5.0mm,以保证术中移除的晶体大小基本一致。记录术前及术后1月前房深度、眼轴长度、晶体后囊膜到视网膜内界膜的距离、裸眼视力、矫正视力、眼压等数值。统计资料均采用SPSS20.0分析。因研究数据符合正态分布、方差齐性等特征,本研究采用单因素方差分析比较4组之间前房深度、矫正视力、裸眼视力、眼轴、眼压及晶体后囊膜至视网膜距离术前术后的变化有无组间差异,p0.05视为有统计学意义。结果:本研究100例患者中男性44例(44%)、女性56例(56%),年龄位于53-86岁(72.28±7.10岁),所有患者均行白内障超声乳化吸出联合人工晶体植入术,术前比较4组患者之间晶体厚度、年龄和性别均无统计学差异(p0.05)。术前裸眼视力组1:0.21±0.06,组2:0.17±0.07,组3:0.06±0.02,组4:0.20±0.08(f=30.569,p=0.000)。术后1月裸眼视力分别为0.54±0.10,0.58±0.10,0.08±0.03,0.56±0.08,裸眼视力差异具有统计学意义(f=216.383,p=0.000)。术前最佳矫正视力组1:0.25±0.09,组2:0.19±0.09,组3:0.08±0.48,组4:0.23±0.10,术后1月最佳矫正视力分别为0.77±0.14,0.85±0.14,0.22±0.10,0.86±0.12,最佳矫正视力差异具有统计学意义(f=140.419,p=0.000)。晶体后囊膜到视网膜距离组1:15.77±1.17mm,组2:15.94±0.72mm,组3:21.03±1.95mm,组416.40±0.87mm,术后1个月组1:17.70±1.22mm,组2:17.89±0.64mm,组3:22.50±1.94mm,组4:18.32±0.67mm。其中组3植入bigbag人工晶体术前术后晶体后囊膜至视网膜距离差值为1.47±0.18mm,与其他三组相比具有统计学意义(p0.05)。眼轴长度:组1由术前23.38±1.10mm减少至23.15±1.02mm,组2由术前23.26±0.68mm减少至23.18±0.67mm,组3由术前28.62±1.85mm减少至术后28.55±1.84mm,组4由术前23.73±0.61mm减少至23.60±0.61mm,手术前后眼轴长度差异显著(f=131.593,p=0.000)。前房深度:术前组1:2.75±0.48mm,组2:2.51±0.39mm,组3:2.78±0.35mm,组4:2.50±0.46mm。术后1月4组前房深度分别加深至3.93±0.54mm,3.69±0.39mm,5.07±0.36mm,3.72±0.46mm。4组患者手术前后前房深度变化有显著性差异(f=54.274,p=0.000)。其中组3植入bigbag人工晶体患者术前术后前方深度差值与其他三组相比有显著差异(p0.05)。眼压:术前组1:16.80±1.44mmhg,组2:16.92±1.66mmhg,组3:16.96±1.46mmhg,组4:16.68±1.35mmhg,术后1月,4组患者眼压分别降至14.84±1.52mmhg,14.80±1.66mmhg,14.92±1.63mmhg,15.08±1.61mmhg。4组患者术前术后眼压虽有差异,但4组之间术前术后眼压变化无统计意义(f=1.695,p=0.173)。结论:白内障手术由于术中摘除了晶状体并植入厚度较小的人工晶体,术后眼内生物测量指标往往发生改变,本研究揭示了以下内容:1.白内障手术改变了眼前节、眼后节等眼内生物测量参数,导致前房加深、晶体后囊膜至视网膜距离增大、眼轴缩短。本研究中这些指标的变化不依赖于术中植入人工晶体的类型,4组患者术前术后上述指标均发生变化,且差异具有统计学意义。2.Bigbag人工晶体的设计能最少地改变晶体后囊膜到视网膜的距离,因此减少白内障摘除后玻璃体前移。该人工晶体对于高度近视患者更有助于支撑玻璃体、维持前房稳定性。由此可见理想的人工晶体可以模仿晶状体的形状和大小,术后更好地支撑玻璃体、维持玻璃体的稳定性、减少玻璃体前移、减少白内障术后如视网膜脱落等并发症的发生。3.4组不同类型人工晶体植入术后患者眼压均降低,但4组之间术前术后眼压变化无统计意义。
[Abstract]:Objective: the study of cataract phacoemulsification combined with intraocular lens implantation after biological measurements and the change of intraocular pressure intraocular artificial lens by measuring different types of design of cataract phacoemulsification combined with intraocular lens implantation after ocular biometric parameters change, and what type of intraocular lens design is more conducive to reduce the surgical effect on eyes section anatomy, reduce postoperative vitreous body forward, and improve the comfort of patients and reduce the incidence of postoperative complications. Materials and methods: retrospective case study. This study collected from March 2016 to January 2017 in 100 cases of the Second Affiliated Hospital of Dalian Medical University pack after phacoemulsification combined with intraocular lens implantation (100 eyes) patients according to the type of intraocular lens. The patients were divided into 4 groups, 25 cases in each group. Group 1 Rayner IOL group, 2 Hoya IOL, 3 Bigbag IOL, 4 ReSTOR IOL group (25 cases). The differences between the groups in order to reduce the thickness of crystal, crystal thickness were included in this study were between 4.0-5.0mm, to ensure that the crystal size of operation removes the records in January are basically the same. The depth of anterior chamber before and after the surgery. The axial length of the eyes, the posterior capsular to retinal membrane distance, uncorrected visual acuity, corrected visual acuity, intraocular pressure. Numerical statistics were analyzed by SPSS20.0. Because of the data to conform to normal distribution, characteristics of homogeneity of variance, this study used single factor analysis of variance between the 4 groups corrected visual acuity, anterior chamber depth, bare visual acuity, eye axis, the distance change before and after surgery to the posterior retinal intraocular pressure and crystals had no difference between the groups, P0.05 is regarded as statistically significant. Results: in this study, 100 cases of male patients in 44 cases (44%), 56 cases (56%), a female age At the age of 53-86 (72.28 + 7.10), all patients underwent phacoemulsification and IOL implantation, preoperative patients in 4 groups were compared between the crystal thickness, there was no significant difference in age and gender (P0.05). The preoperative visual acuity was 1:0.21 + 0.06, 2:0.17 + 0.07, 3:0.06 + 0.02 group, 4:0.20 + 0.08 (f=30.569, p=0.000). The postoperative visual acuity in January were 0.54 + 0.10,0.58 + 0.10,0.08 + 0.03,0.56 + 0.08, with statistically significant difference of uncorrected visual acuity (f=216.383, p=0.000). The preoperative best corrected visual acuity was 1:0.25 + 0.09, 2:0.19 + 0.09, 3:0.08 + 0.48, 4:0.23 0.10 January, postoperative best corrected visual acuity was 0.77 + 0.14,0.85 + 0.14,0.22 + 0.10,0.86 + 0.12, the best corrected visual acuity difference was statistically significant (f=140.419, p=0.000). The posterior capsular distance to the retina of group 1:15.77 + 1.17mm group, 2:15.94 + 0.72mm, 3:21.03 + 1.95mm group, group 41 6.40 + 0.87mm, 1:17.70 + 1.22mm group 1 months after operation, group 2:17.89 + 0.64mm, 3:22.50 + 1.94mm, 4:18.32 + 0.67mm. group in the group 3 bigbag intraocular lens implantation before and after surgery to the posterior capsular retina distance difference was 1.47 + 0.18mm, compared with the other three groups was statistically significant (P0.05). The eye axis length: 1 group from preoperative 23.38 + 1.10mm + 1.02mm group decreased to 23.15, 2 from preoperative 23.26 + 0.68mm + 0.67mm group decreased to 23.18, 3 from preoperative to postoperative reduction of 28.62 + 1.85mm 28.55 + 1.84mm, 4 + 0.61mm decreased from 23.73 preoperatively to 23.60 + 0.61mm, axial length difference before and after surgery significantly (f=131.593, p=0.000). The anterior chamber depth: preoperative group 1:2.75 + 0.48mm, 2:2.51 + 0.39mm, 3:2.78 + 0.35mm, 4:2.50 + 0.46mm. group after operation in January 4 groups respectively the depth of anterior chamber deepened to 3.93 + 0.54mm, 3.69 + 0.39mm, 5.07 + 0.36mm, changes of anterior chamber depth surgery before and after the 3.72 + 0.46mm.4 groups of patients There was significant difference (f=54.274, p=0.000). The group had significant difference between the 3 bigbag intraocular lens implantation in patients with preoperative and postoperative anterior chamber depth difference compared with the other three groups (P0.05). The preoperative intraocular pressure: group 1:16.80 + 1.44mmhg, 2:16.92 + 1.66mmhg, 3:16.96 + 1.46mmhg, 4:16.68 + 1.35mmhg group, after January, 4 groups of patients with intraocular pressure were reduced to 14.84 + 1.52mmhg, 14.80 + 1.66mmhg, 14.92 + 1.63mmhg, 15.08 + 1.61mmhg.4 groups of patients with preoperative and postoperative intraocular pressure although there are differences between the 4 groups, but the change of intraocular pressure before and after surgery had no statistical significance (f=1.695, p=0.173). Conclusion: cataract surgery due to intraoperative removal of the lens and intraocular lens implantation small thickness, postoperative intraocular biometric parameters often change, this study reveals the following contents: 1. cataract surgery changed the anterior segment, posterior segment intraocular biometric parameters, resulting in anterior chamber deepened the posterior capsular to optic network Film distance increases, the axial shortening. The type of changes in these indicators in this study does not depend on the implantation of intraocular lens implantation in the 4 groups of patients before and after the above parameters are changed, the design and the difference was statistically significant.2.Bigbag IOL can at least change the distance to the retinal membrane crystal, thus reducing the after cataract vitreous body forward. The intraocular lens for high myopia patients is helpful to maintain the stability of anterior vitreous body support, artificial crystal. Thus the ideal lens can mimic the shape and size of postoperative vitreous body to better support, maintain the stability of vitreous body, reduce vitreous body forward, reduce intraocular pressure after cataract surgery in patients with different types of intraocular lens implantation after.3.4 group such as retinal detachment and other complications were decreased, but the change of intraocular pressure between the 4 groups before and after surgery had no statistical significance.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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