白内障术后人工晶体（IOL）混浊临床诊治分析（附6例病例报告）

发布时间：2018-03-14 10:41

本文选题：白内障　切入点：IOL混浊　出处：《浙江大学》2010年硕士论文　论文类型：学位论文

【摘要】： [目的] 通过病例回顾和相关基础研究,总结和分析白内障术后IOL混浊的临床表现、诊断和治疗方法,探讨其研究方法、发病机制、诊断标准和治疗思路,从而为IOL混浊的预防、早期诊断和合理治疗提供依据。 [方法] 统计2002年1月至2009年8月期间于浙江大学医学院附属第二医院眼科中心住院病人中诊断为IOL混浊并接受人工晶体置换术的6例病人的临床资料,并运用裂隙灯显微镜观察、扫描电子显微镜(SEM)观察和X线衍射对部分取出的混浊IOL进行临床病理学研究。运用美国国立医学图书馆Pubmed数据库,输入关键词(白内障、人工晶体混浊、超声乳化、人工晶体植入、羟基磷灰石、水凝胶、丙烯酸酯、硅凝胶、人工晶体置换)检索1980-2010年间在线文献数据,全面剖析IOL混浊的发病机制、临床表现、诊断和治疗方法。 [结果] 2002年1月至2009年8月期间本院住院患者中诊断为IOL混浊患者共6例(6只眼),男3例、女3例,平均年龄73.3(68-80)岁,右眼5例、左眼1例,平均IOL植入至发生混浊时间为68(12-122)个月。3例分别伴有葡萄膜炎和高度近视等眼部疾病,6例均分别伴有高血压、糖尿病、风湿病、心律不齐、肺结核等疾病,1例被误诊为后发障并接受YAG激光治疗。所有患者均接受了IOL置换术治疗,术前和术后第一天平均视力分别为0.21±0.09和0.50±0.21,配对t检验P=0.0130.05,差异具有统计学意义。发生混浊的IOL均为水凝胶材料,生产批次集中在2000-2002年间。对其中1枚取出的IOL进行裂隙灯观察示后表面哈气样混浊,扫描电镜下观察示混浊为IOL光学部表面排列疏松紊乱的结晶样小体沉积物,另1枚混浊的IOL表面沉积物X-射线衍射提示混浊IOL有一水磷酸钙物质沉积。 [结论] (1)IOL混浊仅发生于极少数患者,多见于水凝胶等材料,其本质主要为以钙磷混合物为主的各种沉积物沉积于IOL表面。 (2)IOL混浊易被误诊为后发障等疾病并接受错误的治疗。 (3)IOL置换术是有效的治疗方式。
[Abstract]:[purpose]. The clinical manifestations, diagnosis and treatment of IOL opacification after cataract surgery were summarized and analyzed through case review and related basic research. The research methods, pathogenesis, diagnostic criteria and treatment ideas were discussed, so as to prevent IOL opacification. Early diagnosis and reasonable treatment provide basis. [methods]. From January 2002 to August 2009, the clinical data of 6 patients who were diagnosed as IOL opacity and underwent intraocular lens replacement in the eye center of the second affiliated Hospital of Zhejiang University Medical College were analyzed and observed by slit lamp microscope. Scanning electron microscope (SEM) observation and X-ray diffraction were used to study the clinicopathology of partially extracted opacity IOL. The key words (cataract, intraocular lens opacity, phacoemulsification, phacoemulsification) were inputted by the Pubmed database of the National Library of Medicine. Intraocular lens implantation, hydroxyapatite, hydrogel, acrylate, silica gel, intraocular lens replacement (IOL) were searched online from 1980 to 2010 to analyze the pathogenesis, clinical manifestation, diagnosis and treatment of IOL opacity. [results]. From January 2002 to August 2009, 6 patients (3 males and 3 females) were diagnosed as IOL opacification, with an average age of 73.3 years (68-80), right eye (5 cases) and left eye (1 case). The mean time of IOL implantation to opacity was 68 ~ 12 ~ 122) months. 3 cases were associated with uveitis and high myopia, 6 cases with hypertension, diabetes, rheumatism, arrhythmia, etc. One patient with pulmonary tuberculosis and other diseases was misdiagnosed as a posterior obstacle and received YAG laser treatment. All patients were treated with IOL replacement. The mean visual acuity was 0.21 卤0.09 and 0.50 卤0.21 before operation and the first day after operation, respectively. The difference was statistically significant in paired t test (P < 0.0130.05). The opacity of IOL was hydrogel material, and the mean visual acuity was 0.21 卤0.09 and 0.50 卤0.21, respectively. The production batches were concentrated between 2000 and 2002. Slit lamp was used to observe the hazy turbidity on the back surface of one of the IOL samples, and scanning electron microscope showed that the turbidity was the deposit of crystalline bodies with loose arrangement on the surface of the optical part of IOL. Another opacity of IOL surface sediment X-ray diffraction indicates that opacity IOL has calcium phosphate monohydrate deposition. [conclusion]. IOL turbidity occurred only in a few patients and was mainly found in hydrogels and other materials. The essence of the turbidity was the deposition of various sediments mainly composed of calcium and phosphorus mixtures on the surface of IOL. IOL opacification is easily misdiagnosed as a disease such as posterior obstacle and received wrong treatment. IOL replacement is an effective treatment.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66

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