婴幼儿先天性白内障术后并发症及其客观评估技术的研究

发布时间：2018-05-02 06:47

本文选题：先天性白内障 + 并发症　；参考：《广州医科大学》2017年硕士论文

【摘要】：【目的】1.总结前期先天性白内障手术术后并发症发生的总体情况。寻找先天性白内障患者术后评估的新方法。2.研究使用UBM对先天性白内障手术术后并发症的应用价值。3.研究使用基于Off-oxis原理的远红外线眼底反光摄像技术对先天性白内障术后视轴区透明度检查的应用价值。4.研究UBM检查与基于Off-oxis原理的远红外线眼底反光摄像技术联合应用于先天性白内障术后视轴区透明度检查的诊断价值。【方法】1.对2004年4月-2016年12月广州市妇女儿童医疗中心的婴幼儿先天性白内障患者手术的情况进行统计回顾,403例先天性白内障患者(713只眼),男性238例,女性165例,对先天性白内障术后并发症的发生的总体情况进行分析。按不同时期植入人工晶体为两组,A组:3岁以内一期植入人工晶体的患者,93例,138只眼;B组:3岁以内二期植入人工晶体的患者,B组297例,521只眼。手术方式均为:先天性白内障囊外摘除+前段玻璃体切除+人工晶体植入,对两组病人术后的并发症发生情况进行比较,并用X2检验进行统计分析。另外两组按接受手术时的年龄分组,C组:先天性白内障3岁以内行先天性白内障囊外摘除+前段玻璃体切除或白内障囊外摘除+前段玻璃体+人工晶体植入的患者,254例,449只眼;D组:先天性白内障2岁以上行先天性白内障囊外摘除+前段玻璃体切除或白内障囊外摘除+前段玻璃体+人工晶体植入的患者,147例,238只眼,对两组病人术后的并发症发生情况进行比较,并用X2检验进行统计分析。2.对2012年9月-2016年12月广州市妇女儿童医疗中心的婴幼儿先天性白内障术后患者,接受了UBM检查的先天性白内障术后病人,纳入146例先天性白内障患者,235只眼,所有纳入患者同时进行手术显微镜或者裂隙灯显微镜的观察,统计UBM发现的先天性白内障术后并发症的种类,总结UBM术后并发症的图像特征。并用敏感性、特异度评估UBM对于先天性白内障术后并发症的诊断价值。3.对2016年3月-2017年3月所有在广州市妇女儿童医疗中心眼科门诊随访的婴幼儿先天性白内障术后患者进行基于Off-oxis原理的远红外线眼底反光摄像技术、裂隙灯显微镜、UBM或手术显微镜检查,纳入患者132例,218只眼,总结先天性白内障术后并发症基于Off-oxis原理的远红外线眼底反光摄像技术的图像特征,用敏感性、特异度为指标,评估基于Off-oxis原理的远红外线眼底反光摄像技术对于先天性白内障术后视轴区透明度检查的诊断价值。【结果】1.本研究中先天性白内障病人2岁前接受手术的比率为76%,其中3-6月的最多。少数先天性白内障病人在2岁以内植入人工晶体,大多数先天性白内障病人在2岁后植入人工晶体。2.3岁以内分别接受一期和二期植入人工晶体手术的先天性白内障病人术后后发性白内障、虹膜粘连、斜视、继发性青光眼、人工晶体位置异常没有统计学意义,两组术后的并发症无差异。3.2岁以内接受手术的先天性白内障术后并发症病例数高于2岁以后接受手术的先天性白内障患者,两组出现后发性白内障、虹膜粘连并发症的概率有统计学意义,;在2岁以内接受手术的先天性白内障术后出现斜视、眼球震颤病例数少于2岁以后接受手术的先天性白内障患者,差异有统计学意义。两组术后出现继发性青光眼、人工晶体位置异常无统计学差异。4.通过对先天性白内障术后并发症检查的有效性分析,结果表明,UBM对先天性白内障术后后发性白内障、继发性青光眼、虹膜粘连、人工晶体位置异常等术后并发症的诊断的敏感性100%、特异度为96.8%,就实用性分析UBM对先天性白内障术后并发症的诊断的阳性预测值为96.2%,阴性预测值为100%,UBM漏诊率为0,假阳性率为1.1%。5.基于Off-oxis原理的远红外线眼底反光摄像技术和UBM对视轴区透明性的情况进行的有效性分析,结果显示:基于Off-oxis原理的远红外线眼底反光摄像技术对视轴区透明性诊断的敏感性为100%、特异度为97.4%。UBM对视轴区透明性诊断的敏感性为100%、特异度为99.0%。实用性分析的结果显示:基于Off-oxis原理的远红外线眼底反光摄像技术对视轴区透明性诊断的阳性预测值为85.3%,阴性预测值为100%,漏诊率为0,假阳性率为2.6%。UBM对对视轴区透明性诊断的阳性预测值为93.5%,阴性预测值为100%,UBM对对视轴区透明性诊断漏诊率为0,假阳性率为1.04%。【结论】1.本组病人研究结果显示:3岁以内一期植入人工晶体和二期植入人工晶体不是影响先天性白内障术后并发症发生的因素。手术年龄越小,术后发生后发性白内障、虹膜粘连的概率越大,手术年龄越小,术后发生斜视、眼球震颤的概率越小;先天性白内障术后继发性青光眼、人工晶体位置异常的发生与手术年龄无明显关系。2.超声生物显微镜显微镜(UBM)对先天性白内障术后后发性白内障、虹膜粘连、角膜水肿、人工晶体异常等并发症可以显示特异性图像,是一项安全的、诊断价值极高的设备。3.Off-oxis原理的远红外线眼底反光摄像技术,对于对先天性白内障病人视轴区混浊可以显示特异性图像。可以在患儿清醒的状态下、采用非接触、远距离获取视轴区图像,对于术后视轴区混浊检查具有高的敏感性和特异性,是一项安全的、简便的、快捷的检查技术。4.根据UBM检查瞳孔区晶体残留物的大小、形状、厚度,晶体残留物与人工晶体的位置关系、晶体残留物与虹膜的位置,先天性白内障后发障可以分为三种类型:膜性的后发性白内障、皮质再生型、混合型。5.超声生物显微镜显微镜(UBM)检查联合Off-oxis原理的远红外线眼底反光摄像技术可以高效地对先天性白内障术后视轴区透明度检查进行评估。
[Abstract]:[Objective] 1. to summarize the overall situation of postoperative complications after early congenital cataract surgery. A new method for the evaluation of congenital cataract patients.2. study the application value of UBM to the postoperative complications of congenital cataract surgery..3. study on the use of Off-oxis based far infra-red fundus reflexes The application value of opacity examination after cataract surgery.4. study the diagnostic value of UBM examination and Off-oxis based far infra-red ocular fundus imaging technique combined in the visual axis transparency examination after congenital cataract surgery. [Methods] 1. the infants and children of Guangzhou women's and children's Medical Center in December, April 2004, -2016 There were 403 cases of congenital cataract surgery, 403 cases of congenital cataract (713 eyes), 238 men and 165 women. The overall situation of complications after congenital cataract was analyzed. Two groups of intraocular lenses were implanted at different times. Group A: one stage of intraocular lens implantation within 3 years old, 93 cases. 138 eyes, 138 eyes, group B: two cases of intraocular lens implantation within 3 years of age, 297 cases in group B and 521 eyes. The surgical methods were: congenital cataract extracapsular removal + anterior vitrectomy plus intraocular lens implantation. The postoperative complications of the two groups were compared and the X2 test was used for statistical analysis. The other two groups were treated according to the year of operation. Group C: Patients with congenital cataract under 3 years of age were treated with extracapsular cataract extraction + anterior vitrectomy or extracapsular cataract extraction + anterior vitreous and intraocular lens implantation, 254 cases, 449 eyes, and group D: congenital cataract above 2 years of age for congenital cataract extracapsular cataract extraction, anterior vitrectomy or extracapsular cataract extraction + + cataract The patients with anterior vitreous and intraocular lens implantation, 147 cases and 238 eyes, were compared with the postoperative complications of the two groups, and the X2 test was used to analyze.2. for the congenital cataract after the congenital cataract in the Guangzhou women and children's medical center of Guangzhou in December September 2012, and the congenital cataract surgery was performed by UBM examination. The postpatients were included in 146 cases of congenital cataract and 235 eyes. All the patients were observed at the same time with surgical microscope or slit lamp microscope. The types of postoperative complications of congenital cataract were found by UBM, and the image characteristics of complications after UBM were summarized. And the sensitivity and specificity of UBM for congenital cataract surgery were evaluated. The diagnostic value of postcomplications.3. was carried out in all patients after congenital cataract surgery in the ophthalmology clinic of Guangzhou women and children's Medical Center in March March 2016. The remote infrared ray photography technique based on Off-oxis principle, slit lamp microscope, UBM or surgical microscope examination were carried out in 132 cases and 218 eyes in 218 eyes. To sum up the image features of the far infrared fundus reflexes based on the Off-oxis principle, and to evaluate the diagnostic value of the remote infrared imaging technique based on the principle of Off-oxis for the examination of the optic axis transparency after congenital cataract surgery. [results] 1. In the study, the rate of surgery for congenital cataract patients before 2 years of age was 76%, of which 3-6 months were the most. A few congenital cataract patients implanted intraocular lenses within 2 years of age, and most of the congenital cataract patients were implanted with intraocular lens implantation and intraocular lens implantation within.2.3 years after 2 years of age. Postoperatively postoperatively, posterior cataract, synechia, strabismus, secondary glaucoma, and abnormal intraocular lens position were not statistically significant. There was no difference in postoperative complications between the two groups. The number of postoperative complications of congenital cataract was higher than that of 2 years old after.3.2 years of age, and the two groups had postoperatively white postoperatively. The probability of complications of cataract and synechia was statistically significant. There was a significant difference in the incidence of strabismus after surgery under 2 years of congenital cataract, and the number of nystagmus cases was less than 2 years old. The difference was statistically significant in the two groups. Differential.4. is an effective analysis of postoperative complications of congenital cataract surgery. The results show that the sensitivity of UBM to postoperative complications such as post-operative cataract, secondary glaucoma, synechia, and abnormal intraocular lens position in congenital cataract surgery is 100%, and the specificity is 96.8%. The practical analysis of UBM for congenital cataract The positive predictive value of the postoperative complications was 96.2%, the negative predictive value was 100%, the UBM missed diagnosis rate was 0, the false positive rate was 1.1%.5. based on Off-oxis principle and the efficiency analysis of the transparency of the visual axis area by the far infrared ray fundus imaging and the UBM. The results showed that the far infrared fundus reflexes based on the Off-oxis principle The sensitivity of the technique to the diagnosis of optic axis transparency is 100%. The sensitivity of the specificity of 97.4%.UBM to the diagnosis of transparency in the optic axis area is 100%. The result of the specificity of the 99.0%. analysis shows that the positive predictive value of the remote infrared imaging technique based on the Off-oxis principle is 85.3% for the diagnosis of the transparency of the visual axis and the negative predictive value. For 100%, the rate of missed diagnosis was 0, the false positive rate was 93.5%, the negative predictive value was 100%, the negative predictive value was 100%, and the false positive rate was 0 and the false positive rate was 1.04%. [Conclusion] (Conclusion] 1. group of patients were implanted intraocular lens and two phase implanted intraocular lens within 3 years of age of 3 years. The results showed that the false positive rate was 0 and the false positive rate was 1.04%.. It is not the factors that affect the postoperative complications of congenital cataract surgery. The smaller the operation age, the postoperatively post cataract, the greater the probability of the synechia of the iris, the smaller the age of the operation, the postoperative strabismus, the smaller the probability of the nystagmus, the secondary green eyes after the congenital cataract surgery, the occurrence of the abnormal position of the intraocular lens and the operation age. The.2. ultrasound biomicroscope microscope (UBM) is a safe and highly diagnostic device for the congenital cataract after cataract, iris adhesion, corneal edema, and intraocular lens abnormalities. It is a safe and highly diagnostic device for.3.Off-oxis. The opacities in the optic axis area of the cataract patients can display the specific image. It is possible to use non contact and distance to obtain the visual axis image under the sober condition of the children. It has high sensitivity and specificity for the opacification examination of the postoperative visual axis area. It is a safe, simple, quick and quick examination technique for the examination of the residual lens in the pupil based on.4.. The size, shape, thickness, the relationship between the crystal residuals and the position of the intraocular lens, the position of the crystal residuals and the iris, and the congenital posterior cataract can be divided into three types: membranous posterior cataract, cortical regenerative type, mixed.5. ultrasound biomicroscope microscopy (UBM) examination combined with the remote infra-red fundus of the Off-oxis principle The technology of Reflective Photography can evaluate the opacity of congenital cataract after operation.

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

【参考文献】