前房型人工晶状体取出术原因分析

发布时间：2018-01-25 04:17

本文关键词： 前房型人工晶状体角膜内皮失代偿继发性青光眼人工晶状体脱位瞳孔椭圆化并发性白内障　出处：《浙江大学》2015年博士论文　论文类型：学位论文

【摘要】：目的：数十年来,前房型人工晶状体在临床上的广泛引用使其术后并发症愈发引起眼科医生重视,本研究旨在对有无晶体眼两类前房型人工晶状体取出术原因进行分析,以期为临床医生提供指导。方法：对浙江大学医学院附属第二医院眼科中心2008.01至2015.02期间收治入院的40例前房型人工晶状体取出术患者的临床资料进行回顾性分析,从有晶体眼前房型人工晶状体以及无晶体眼前房型人工晶状体两个角度对其取出术原因进行分析；并利用Wilcoxon秩和检验对取出前术后眼压进行对比,同时对患者术前视力与角膜内皮细胞密度、细胞面积标准差以及六边形细胞比例等相关参数进行相关性分析。结果：在40例病例(包括有晶体眼前人工晶状体15例及无晶体眼前房型人工晶状体25例)中,前房型人工晶状体取出术原因：角膜内皮失代偿占47.5%,继发性青光眼占7.5%,人工晶状体脱位12.5%,并发性白内障7.5%,继发性青光眼合并角膜内皮失代偿12.5%,其他12.5%。有晶体眼前房型人工晶状体取出术原因中前3位分别为角膜内皮失代偿(73.3%),并发性白内障(20%),角膜内皮失代偿合并继发性青光眼(6.7%)。而角膜内皮失代偿(32%)、人工晶状体脱位(20%)、继发性青光眼合并角膜内皮失代偿(16%)则为无晶体眼前房型人工晶状体取出术原因前3位。无论有无晶体眼,角膜内皮失代偿均为主要取出术原因,且主体发生于植入术后10年及以上。有晶体眼前房型人工晶状体取出术病例中,瞳孔椭圆化并发率为46.7%。前房型人工晶状体取出术前眼内压均值为23.8±14.5mmHg,显著高于取出术后眼内压16.8±9.8mmHg(p0.05).有晶体眼前房型人工晶体取出术前角膜内皮细胞细胞面积标准差与术前最佳矫正视力具有显著相关性(p0.05). 结论：角膜内皮失代偿是前房型人工晶状体取出术的主要原因；前房型人工晶状体取出术后眼内压较术前发生显著降低；术前最佳矫正视力的恶化程度与角膜内皮细胞的形态学异常呈显著相关性,这对取出术后角膜内皮细胞的预后具有提示作用。
[Abstract]:Objective : In the past few decades , the extensive reference of anterior chamber intraocular lens ( IOL ) in clinical practice has resulted in more and more attention paid by ophthalmologists . The aim of this study is to analyze the reasons for the removal of anterior chamber intraocular lens ( IOL ) with the presence or absence of crystalline eye , with a view to providing guidance to clinicians . Methods : The clinical data of 40 patients with anterior chamber intraocular lens ( IOL ) who were admitted to the hospital from January 2008 to 2015 were analyzed retrospectively , and the reasons of removal were analyzed from two angles of anterior chamber intraocular lens and no - crystal anterior chamber intraocular lens . The correlation of preoperative visual acuity and corneal endothelial cell density , cell area standard deviation and hexagonal cell ratio were analyzed . Results : In 40 cases ( including 15 cases with lens anterior lens and 25 cases without lens anterior chamber intraocular lens ) , anterior chamber intraocular lens was removed for the reason : corneal endothelium decompensated , secondary glaucoma 7.5 % , intraocular lens dislocation 12.5 % , cataract 7.5 % , secondary glaucoma combined with corneal endothelium decompensated 12.5 % , and other 12.5 % . Conclusion : The corneal endothelium decompensated is the main reason of anterior chamber intraocular lens removal . The anterior chamber intraocular pressure ( IOL ) is significantly lower than that before operation . The degree of deterioration of the best corrected visual acuity before operation is significantly correlated with the morphological abnormality of the corneal endothelium , which is indicative of the prognosis of corneal endothelium after removal .

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R779.6

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