不同颜色人工晶体全视野视网膜电图差异性探讨

发布时间：2017-12-30 20:38

本文关键词：不同颜色人工晶体全视野视网膜电图差异性探讨　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：伴随着蓝光越来越多的被应用于我们的日常生活，蓝光引起的视网膜光损伤效应已经逐渐被人们所意识到，白内障术后患者由于缺少了晶状体的光线滤过，尤其应该重视蓝光造成的视网膜光损伤。本研究通过比较透明单焦点人工晶体与蓝光滤过型单焦点人工晶状体在全视野视网膜电图方面的差异性，来评价不同人工晶状体对人眼视网膜功能的影响以及蓝光滤过型人工晶状体的视网膜保护作用。方法：选取2013年3月至2013年12月于大连医科大学附属第二医院眼科行白内障超声乳化吸出联合人工晶体植入术患者，满足入选及排除标准，随机将其分为两组，对照组植入Rayner SuperflexR（透明非球面单焦点人工晶状体），实验组植入HOYA PY-60AD（蓝光滤过型非球面单焦点人工晶状体），对其进行随访，资料完整者76人（82只眼）。其中对照组共36人（40只眼），男性18例21只眼，女性18例19只眼，Emery核硬度分级Ⅱ级核15只眼，Ⅲ级核18只眼，Ⅳ级核7只眼。实验组共40人（42只眼），男性20例20眼，女性20例22只眼。Emery核硬度分级Ⅱ级核16只眼，Ⅲ级核19只眼，Ⅳ级核7只眼。分别于术前1天、术后1个月、术后3个月12:00-14:00，由同一名熟练操作者操作，运用罗兰视觉电生理系统，进行全视野视网膜电图检查。观察国际标准化方案的六项指标，并进行统计学分析。结果：（1）对照组暗适应0.01ERG、暗适应3.0ERG、暗适应10.0ERG、暗适应3.0振荡电位p波振幅、明适应3.0ERG、明适应3.0闪烁ERG术后隐含期较术前缩短、振幅升高，差别有统计学意义（P0.05），术后一个月与术后三个月之间差别无统计学意义（P0.05）。暗适应3.0振荡电位p波隐含期术前、术后一个月、术后三个月之间差别无统计学意义（P0.05）。（2）实验组暗适应0.01ERG、暗适应3.0ERG、暗适应10.0ERG、暗适应3.0振荡电位、明适应3.0ERG、明适应3.0闪烁ERG术后较术前差别有统计学意义（P0.05），术后一个月与术后三个月之间差别无统计学意义（P0.05）。其中，，除暗适应10.0b波隐含期术后较术前延长外，术后隐含期均较术前缩短，振幅术后均较术前升高。（3）对照组暗适应10.0ERG较暗适应3.0ERG a波隐含期缩短，a波振幅升高，差别有统计学意义（P0.05），b波差别无统计学意义（P0.05）。实验组暗适应10.0ERG较暗适应3.0ERG隐含期缩短，a波振幅升高，差别有统计学意义（P0.05），b波振幅差别无统计学意义（P0.05）。（4）术后一个月，实验组暗适应3.0b波隐含期、暗适应10.0b波隐含期较对照组延长，差别有统计学意义（P0.05）；暗适应10.0a波振幅、暗适应振荡电位p波振幅、明适应3.0闪烁ERG振幅较对照组升高，差别有统计学意义（P0.05）。余指标两组之间差别无统计学意义（P0.05）。术后三个月，实验组暗适应3.0b波隐含期、暗适应10.0b波隐含期较对照组延长，差别有统计学意义（P0.05）；暗适应振荡电位p波隐含期较对照组缩短，差别有统计学意义；暗适应振荡电位p波振幅、明适应3.0闪烁ERG振幅较对照组升高，差别有统计学意义（P0.05）。余指标两组之间差别无统计学意义（P0.05）。结论：白内障会引起全视野视网膜电图隐含期延长、振幅缩短。给予高强度光照射可以减少由白内障引起的全视野视网膜电图的改变，有利于对白内障患者视网膜情况的评估及术后视力的预测。蓝光滤过型人工晶状体由于滤过了部分蓝光，使患者暗适应隐含期延长，影响其暗视敏感度。蓝光滤过型人工晶状体在小样本术后三个月的随访中，显现出对黄斑区及内层视网膜的保护作用，期待日后大样本长期随访的临床试验加以证实。
[Abstract]:Objective: with the blue light are used more and more in our daily life, blue light caused by light induced retinal damage effect has been gradually recognized, after cataract surgery patients due to the lack of a light filtering lens, especially should pay attention to the blue light from the light induced retinal injury. This study compares the transparent single focus intraocular lens and blue filtration type single focus intraocular lens differences in full field ERG aspects, to evaluate the effects of different intraocular lens on human retinal function and blue light filtering intraocular lens retina protection.
Methods: from March 2013 to December 2013 in the Second Affiliated Hospital of Dalian Medical University ophthalmology patients underwent phacoemulsification combined with intraocular lens implantation, meet the inclusion and exclusion criteria, were randomly divided into two groups, the control group SuperflexR implanted Rayner (transparent aspheric monofocal intraocular lens implanted in the experimental group, HOYA PY-60AD) (blue lightfiltering aspheric surface single focus intraocular lens), were followed up for the complete data of 76 people (82 eyes) in the control group. A total of 36 people (40 eyes), 18 cases of male 21 cases, female 18 cases 19 eyes, Emery nuclear hardness grade II III nuclear nuclear 15 eyes, 18 eyes, nuclear grade 7 eyes of experimental group. A total of 40 people (42 eyes), 20 eyes of 20 cases of male, female 20 cases 22 eyes of.Emery nuclear hardness grade II III nuclear nuclear 16 eyes, 19 eyes, 7 eyes respectively. Nuclear grade 1 day before surgery, 1 months after surgery, 3 months after the operation 12:00-14:00, The operation was performed by the same skilled operator. The whole field electroretinogram was examined by Loran's visual electrophysiological system. Six indexes of the international standardization program were observed and analyzed statistically.
Results: (1) the control group 0.01ERG 3.0ERG dark adaptation, dark adaptation, dark adaptation 10.0ERG, dark adaptation 3 oscillatory potentials of P wave amplitude, photopic 3.0ERG, light adaptation 3 scintillation after ERG implicit time were shorter, the amplitude increased, the difference was statistically significant (P0.05), the difference between three months after operation one month after surgery and had no statistical significance (P0.05). 3 dark adapted oscillatory potentials of P wave implicit time before operation, one month after the operation, the postoperative difference between three months was not statistically significant (P0.05).
(2) 0.01ERG dark adaptation of the experimental group, the dark adaptation 3.0ERG, dark adaptation 10.0ERG, dark adaptation 3 oscillatory potentials, photopic 3.0ERG, light adaptation 3 flashing ERG after operation there was a statistically significant difference (P0.05), postoperative difference between three months and one month after surgery had no statistical significance (P0.05) in addition to dark adaptation. The 10.0b wave implicit time after operation is extended, implicit time were shortened after operation, postoperative amplitude increase significantly.
(3) the control group 10.0ERG was dark adaptation dark adaptation 3.0ERG a wave latent period is shortened, the amplitude of a wave increased, the difference was statistically significant (P0.05), b wave had no significant difference (P0.05). The experimental group was dark adaptation dark adaptation 10.0ERG 3.0ERG implied period is shortened, the amplitude of a wave increased, the difference was statistically significant (P0.05), b wave amplitude difference was not statistically significant (P0.05).
(4) a month after the operation, the experimental group of dark adaptation of 3.0b wave implicit time, dark adaptation of the 10.0b wave implicit time longer than the control group, the difference was statistically significant (P0.05); dark adaptation of 10.0a wave amplitude, P wave amplitude of oscillatory potentials of dark adaptation, photopic 3 scintillation amplitude of ERG increased compared with the control group, there was statistical significant differences (P0.05). Other indexes between the two groups had no significant difference (P0.05).
Three months after surgery, the experimental group of dark adaptation of 3.0b wave implicit time, dark adaptation of the 10.0b wave implicit time longer than the control group, the difference was statistically significant (P0.05); dark adaptation of oscillatory potentials of P wave implicit time shorter than the control group, the difference was statistically significant; the dark adaptation of the oscillatory potentials of P wave amplitude, 3 flashing light adaptation the amplitude of ERG increased compared with the control group, the difference was statistically significant (P0.05). Other indexes between the two groups had no significant difference (P0.05).
Conclusion: the cataract caused by full field ERG implicit period, amplitude is reduced. Given the high intensity light irradiation can reduce the electroretinogram changes caused by cataract, visual acuity assessment and prediction for surgery for cataract patients after retinal conditions. Blue light filtering intraocular lens due to the filtering some blue, make the patient the implicit dark adaptation period is prolonged, affecting the scotopic sensitivity. Blue light filtering intraocular lens in the follow-up of three months after the operation in the small sample, showing protective effect on macular and inner retina, look forward to days after long-term follow-up of large sample clinical trials to confirm.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R779.6

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