IOL Master在轴性高度近视并发性白内障及穿透性角膜移植术后的临床应用

发布时间：2018-03-01 09:54

本文关键词： IOL Master 轴性高度近视 PKP术后并发性白内障　出处：《济南大学》2012年硕士论文　论文类型：学位论文

【摘要】：第一部分IOL Master应用于轴性高度近视并发性白内障患者的临床观察目的对IOL Master应用于轴性高度近视并发性白内障患者生物测量和人工晶状体度数预测的准确性进行研究，为临床应用提供参考依据。方法收集2006年8月至2012年3月因高度近视并发性白内障于我院行手术治疗且资料完善的患者78例112眼。男29例，女49例；年龄19-82岁，平均55.8岁，全部患者均行白内障超声乳化吸除联合折叠式人工晶状体植入手术治疗。术前最佳矫正视力为HM~0.6，屈光度为-6.00~-29.00D，眼轴长度26mm。按照眼轴长度（AL）进行分组，分为26mmAL≤28mm组43眼，28mmAL≤30mm组33眼，AL30mm组36眼。术前分别应用接触性A超联合角膜曲率计和IOL Master行生物测量和人工晶状体度数预测，术后三个月行规范主觉验光。比较两种测量方式的检出率，眼轴长度、角膜曲率、前房深度以及人工晶状体预测度数的差异和相关性，根据不同的眼轴长度计算比较术后绝对屈光误差并分析其差异。采用SPSS17.0统计软件进行数据分析，率的比较采用卡方检验，配对资料的比较采用配对t检验，成组资料的比较采用单因素方差分析，两种仪器间测量所得数据的相关性采用Pearson相关分析，两种仪器测量的所得数据的一致性检验用Bland-Altman图表示，以P0．05为差异有统计学意义。结果 1．IOL Master对轴性高度近视并发性白内障的检出率为83.9%，接触性A超联合角膜曲率计的检出率为100%，两者比较差异有统计学意义（P=0），对于晶状体混浊重的患者中，传统方法的检出率高于IOL Master。 2．接触性A超测得的AL为（29.16±2.38）mm，IOL Master测得的AL为（29.35±2.49）mm，两者比较差异存在统计学意义（P=0），两者具有高度相关性（r=0.99，P=0）。随着眼轴长度的增加，IOL Master和接触性A超所测得的眼轴长度差逐渐增大，分别为0.04mm，0.18mm，0.28mm。 3．角膜曲率计测得的角膜曲率Km为（44.31±1.45）D，IOL Master测得的Km为（44.20±1.45）D，两者比较差异有统计学意义，两者具有高度相关性。 4．接触性A超和IOL Master所测得的前房深度比较差异无统计学意义（t=-1.518，P=0.134）。 5．按照SRK/T公式，IOL Master计算的IOL度数为（3.63±6.36）D，接触性A超联合角膜曲率计计算的IOL度数为（3.36±6.49）D，两者比较差异有统计学意义（t=7.152，P=0），两者具有高度相关性（r=0.99，P=0）。应用IOL Master四种公式所测得的IOL度数比较差异无统计学意义（F=0.027，P=0.994）。 6．IOL Master和接触性A超联合角膜曲率计术前预留屈光度分别为（-0.93±0.58）D，（-1.02±0.41）D，术后三个月等效球镜为（-0.42±0.69）D，与前两者比较差异均有统计学意义（t1=-3.568，P=0.001；t2=-4.829，P=0）。 7．应用IOL Master以SRK/T公式计算，三组术后术后绝对屈光误差分别为（0.10±0.31）D、（0.73±0.34）D、（1.19±0.77）D，三者比较差异有统计学意义（F=25.87，P=0），随眼轴长度的增加，术后绝对屈光误差增加。8应用IOL Master的SRK/T公式预测IOL度数，将术后绝对屈光误差与术前前房深度测量值进行Pearson相关性分析，r=0.186，P=0.237（P0.05），两者之间不存在明显相关关系。结论 IOL Master应用于轴性高度近视患者人工晶状体度数预测的准确性高于接触性A超联合角膜曲率计，但对于晶状体核Ⅳ级或严重的皮质、后囊下混浊的病例，其检出率较低，在临床应用中仍不能完全取代传统测量方法。随着眼轴长度的增加，IOL Master预测人工晶状体度数的术后绝对屈光误差增加，需要根据不同的眼轴长度选择合适的人工晶状体度数，以避免术后出现过矫。第二部分IOL Master应用于穿透性角膜移植术后的临床观察目的通过IOL Master和A超联合Oculyzer对穿透性角膜移植术后患者行生物学测量及人工晶状体度数预测，探讨IOL Master应用于PKP术后的准确性。方法收集2012年1月到2012年4月期间穿透性角膜移植手术后于山东省眼科医院复查的患者15例（16眼），其中男性9例，女性6例，平均年龄34岁（21-48岁），角膜植片直径为7.5-8.5mm，裸眼视力为FC-0.6，全部患者角膜植片透明，未发现明显角膜植片免疫排斥反应或排斥反应已治愈3个月，眼部无充血，前房无明显炎症反应。所有患者均采用IOL Master500和接触性A超联合眼前节分析系统（Oculyzer）行人工晶状体（IOL）度数测算。分别比较两种测量方式的检出率，以及测量眼轴长度、角膜曲率、前房深度的差异和相关性，比较人工晶状体度数预测的准确性。采用SPSS17.0统计软件进行数据分析，率的比较采用卡方检验，配对资料的比较采用配对t检验，成组资料的比较采用单因素方差分析，两种仪器间测量所得数据的相关性采用Pearson相关分析，以P0．05为差异有统计学意义。结果 1．IOL Master和接触性A超对PKP术后眼轴长度的检出率比较差异无统计学意义（X2=1.032，P=0.310）。IOL Master对PKP术后角膜曲率的检出率为56.25%，Oculyzer角膜曲率的检出率为100%，两者比较差异有统计学意义（X2=8.96，P=0.003）。 2．IOL Master所测得的眼轴长度为（23.47±1.55）mm，接触性A超所测得的眼轴长度为（23.31±1.53）mm，IOL Master所测眼轴长度比A超长0.16mm，两者比较差异存在统计学意义（t=-4.153，P=0.002），两者存在高度相关性（r=0.99，P=0）。 3．IOL Master所测得的Km为（41.49±3.22）D，Oculyzer所测得的Km为（43.0±2.41）D，两者比较差异有统计学意义（t=4.571，P=0.006），两者存在高度相关性。IOL Master所测得的散光度为（9.04±3.96）D，Oculyzer所测得的散光度为（6.70±1.64）D，两者比较差异无统计学意义（t=-2.469，P=0.057），两者存在高度相关性。 4．接触性A超所测得的前房深度为（2.77±0.39）mm，IOL Master所测得的前房深度为（2.82±0.44）mm，Oculyzer所测得的前房深度为（2.90±0.50）mm，三种测量方法两两比较差异均有统计学意义（t1,2=-2.388，P=0.036；t2,3=-3.370，P=0.006；t1,3=-4.225，P=0.001）。 5．按照SRK/T公式计算IOL度数，IOL Master所测得为（28.18±7.61）D，接触性A超联合Oculyzer所测得的为（26.01±6.26）D，两者比较差异存在统计学意义（t=-5.892，P=0）。结论 IOL Master对穿透性角膜移植术后患者行生物学测量，其角膜曲率的检出率明显低于Oculyzer，其眼轴长度的测量较接触性A超准确，但角膜曲率测量的准确性较Oculyzer差，因此在临床上对穿透性角膜移植术后患者行人工晶状体度数预测时应综合两种仪器的测量结果，同时考虑缝线等影响因素，，才能选择出更加合适的人工晶状体度数。
[Abstract]:The clinical observation of the first part of IOL Master in patients with complicated cataract with axial high myopia
objective
Objective to study the accuracy of biometric and intraocular lens degree prediction of IOL Master in patients with cataract complicated by axial high myopia, so as to provide reference for clinical application.
Method
From August 2006 to March 2012 for cataract with high myopia in our hospital for surgical treatment of patients with complete data of 78 eyes of 112 cases. 29 cases were male, 49 were female; the average age is 19-82 years old, 55.8 years old, all the patients underwent phacoemulsification and foldable intraocular lens implantation surgery. Preoperative best corrected visual acuity HM~0.6, diopter -6.00~-29.00D, axial length 26mm. in accordance with the axial length (AL) were divided into 26mmAL 28mm group 43 eyes, 28mmAL 30mm group 33 eyes, 36 eyes in group AL30mm before operation respectively. Application of contact A ultrasound combined with corneal curvature and IOL meter Master for biological measurement and intraocular lens the degree of prediction, three months after the operation of subjective refraction. The detection rate of two kinds of measurement methods, axial length, corneal curvature, anterior chamber depth and intraocular lens degree prediction difference and correlation, according to different axial length Calculation and comparison of postoperative absolute refractive errors and analysis the differences. The data were analyzed by SPSS17.0 statistical software, were compared using the chi square test, paired data were compared using paired t test was used to compare group data of single factor variance analysis, two kinds of instruments between the measured data correlation analysis using Pearson correlation, consistency two kind of test instrument for measuring the data show in Bland-Altman, with P0.05 as the difference was statistically significant.
Result
The detection rate of 1.IOL Master for axial high myopia complicated cataract is 83.9%, and the detection rate of contact A ultra combined corneal curveter is 100%, the difference between them is statistically significant (P=0). For turbidity heavy patients, the detection rate of traditional method is higher than that of IOL Master..
2. contact A measured AL (29.16 + 2.38) mm, IOL Master AL measured for (29.35 + 2.49) mm, there was significant difference between the two groups (P=0), the two are highly correlated (r=0.99, P=0). With the increase of axial length, axial length of IOL and Master contact A the measured difference increases, respectively 0.04mm, 0.18mm, 0.28mm.
3. the corneal curvature Km measured by corneal curvature meter was (44.31 + 1.45) D, and the Km measured by IOL Master was (44.20 + 1.45) D, the difference between them was statistically significant, and the correlation between them was highly correlated.
There was no significant difference in the depth of anterior chamber between 4. contact A and IOL Master (t=-1.518, P=0.134).
5. according to the SRK/T formula, IOL Master calculation of the IOL degree (3.63 + 6.36) D, A ultrasound combined with corneal curvature contact calculation IOL degree (3.36 + 6.49) D, the difference was statistically significant (t=7.152, P=0), the two are highly correlated (r=0.99, P=0) had no statistical significance. Should as measured by IOL Master four formula IOL degree difference (F=0.027, P=0.994).
6.IOL Master and contact A ultrasound combined with corneal curvature before surgery for diopter respectively (-0.93 + 0.58) D, (-1.02 + 0.41) D, three months after the operation for the spherical equivalent (-0.42 + 0.69) D, compared with the former two differences were statistically significant (t1=-3.568, P=0.001; t2=-4.829, P =0).
7. application of IOL Master calculated by SRK/T formula, three groups of postoperative absolute refractive error were (0.10 + 0.31) D, (0.73 + 0.34) D, (1.19 + 0.77) D, there was a significant difference between the three groups (F=25.87, P=0), with the increase of axial length, postoperative absolute the refractive error formula of.8 application of IOL Master SRK/T increased IOL to forecast the degree of postoperative absolute refractive error and preoperative anterior chamber depth measurements were analyzed by Pearson correlation analysis, r=0.186, P=0.237 (P0.05), there was no significant correlation between the two.
conclusion
The accuracy of IOL application of Master in high myopia patients with IOL prediction than contact A ultrasound combined with corneal keratometer, but for the lens nucleus IV or severe cortex, posterior capsule opacification cases, the detection rate is relatively low, still can not completely replace the traditional measurement methods in clinical application. With the increase of eye the axial length of the IOL Master prediction of intraocular lens after absolute refractive error increases, need to be chosen according to the different axial lengths of the intraocular lens, in order to avoid postoperative overcorrection.
The clinical observation of second parts of IOL Master after penetrating keratoplasty
objective
IOL Master and A combined with Oculyzer were used to predict the accuracy of IOL Master in PKP after penetrating keratoplasty.
Method
To review 15 cases of Eye Hospital of Shandong province were collected during January 2012 to April 2012 after penetrating keratoplasty (16 eyes), there were 9 males and 6 females, the average age of 34 years (21-48 years), corneal diameter 7.5-8.5mm, uncorrected visual acuity was FC-0.6, all patients with corneal transparence. No obvious corneal graft rejection or rejection have been cured for 3 months, no ocular hyperemia, no obvious inflammatory reaction in the anterior chamber. All patients were treated with IOL and Master500 contact A ultrasound combined with anterior segment analysis system (Oculyzer) artificial lens (IOL) power calculation. The detection rate were compared between the two groups the way of measurement, and the measurement of axial length, corneal curvature, anterior chamber depth difference and correlation, comparing the accuracy of intraocular lens power prediction. Using SPSS17.0 statistical software for data analysis, rate compared with chi square test, paired. The paired t test was used to compare the data. Single factor ANOVA was used to compare the data between groups. The correlation between measured data between two instruments was Pearson correlation analysis, and the difference between P0.05 was statistically significant.
Result
1.IOL Master and A on contact and there was no significant difference in the detection rate of axial length after PKP (X2=1.032, P=0.310).IOL Master PKP on the postoperative corneal curvature detection rate was 56.25%, the detection of Oculyzer corneal curvature rate was 100%, the difference was statistically significant (X2=8.96, P=0.003).
The axial length measured by 2.IOL Master for (23.47 + 1.55) mm, axial length of contact A measured for (23.31 + 1.53) mm, IOL measured by Master axial length than the length of A 0.16mm, there was significant difference between the two groups (t=-4.153, P=0.002), the two are highly correlated (r=0.99, P=0).
The measured 3.IOL Master Km (41.49 + 3.22) D, measured by the Oculyzer Km (43 + 2.41) D, the difference was statistically significant (t=4.571, P=0.006), there is a high correlation between the astigmatism measured.IOL by Master (9.04 + 3.96) D, astigmatism was measured by the Oculyzer (6.70 + 1.64) D, there was significant difference between the two groups (t=-2.469, P=0.057), both of them are highly correlated.
4. contact A measurement of anterior chamber depth (2.77 + 0.39) mm, IOL Master measured the anterior chamber depth (2.82 + 0.44) mm, Oculyzer measured the anterior chamber depth (2.90 + 0.50) mm, 22 three measurement methods were statistically significant (t1,2=-2.388, P= 0.036; t2,3=-3.370, P=0.006; t1,3=-4.225, P=0.001).
5., the IOL degree was calculated according to the SRK/T formula. The IOL Master was measured as (28.18 + 7.61) D, and the contact A A combined Oculyzer was (26.01 + 6.26) D, the difference was statistically significant (t=-5.892, P=0).
IOL Master on penetrating keratoplasty in patients after biological measurements, the corneal curvature detection rate was significantly lower than that of Oculyzer, the measurement of axial length of contact A super accurate, but the accuracy of measurement of corneal curvature was lower than Oculyzer, and should therefore be comprehensive measurement results of two kinds of instruments for penetrating keratoplasty in lens displacement prediction artificial degree after transplantation in clinic at the same time, considering the influence factors of seam in order to select a more appropriate, the intraocular lens.

【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

【参考文献】