儿童白内障手术人工晶状度数计算准确性的研究

发布时间：2018-03-23 11:50

本文选题：白内障　切入点：先天性　出处：《山东大学》2011年硕士论文

【摘要】：目的儿童白内障是导致全球范围内,特别是发展中国家儿童盲的最主要原因。白内障的发生可严重的抑制婴幼儿早期视力的发育。白内障患儿尽早行手术治疗。已得到广泛认可。人工晶体植入术亦成为术后矫正屈光状态的最主要手段。先天性白内障患儿眼球处于生长发育阶段,早期屈光状态有明显变化。眼轴短,角膜曲率陡峭,前房深度浅,术后屈光目标为非正视状态,均增加IOL计算的复杂性。术者需准确计算IOL度数,达到预期的术后屈光状态,最大程度的提高患儿视力。因此,准确计算IOL度数具有重要意义。本研究应用SRKⅡ公式计算先天性白内障患儿IOL晶体度数,术后通过检影验光检测其屈光状态,以检测术前IOL度数选择的准确性。为先天性白内障患儿IOL度数选择提供依据。方法收集2008年9月至2010年9月行先天性白内障摘除+IOL植入术的患儿37例。年龄为1.6～6.8岁,平均年龄为2.9±1.3岁。所有患儿均需行手术治疗。术前及术后伴青光眼的患儿排除在此研究范围。测量前按10%水合氯醛1 ml/kg给予患儿口服或灌肠。患儿熟睡后行A超(ODM-1000A)测量眼轴。使用SRKⅡ公式计算,根据正常人角膜曲率平均值43.5D,引用晶体A常数(A=118.0),2岁及以内小儿IOL度数欠矫20%,2～8岁间的小儿欠矫10%,计算IOL度数。术后2个月行视网膜检影验光,测量实际屈光状态的等效球镜(等效球镜=球镜十柱镜/2)。计算术眼预期术后屈光度和术后实际测得屈光度差值的绝对值,即绝对预测误差(绝对预测误差=|预期术后屈光度—术后实际测得屈光度|)。绝对预测误差越小,表明预期术后屈光度误差越小,IOL计算准确性越高。比较不同年龄、眼轴长度、IOL植入时机与IOL计算准确性的关系,分组间差异使用U检验,P值0.05视为差异显著。结果 1.共计62眼中,眼轴从17.74mm-26.27mm不等,平均值为21.12±1.68mm。眼轴随着年龄增长逐渐增加。本研究中,眼轴20mm患儿年龄均小于2岁。 2.全组绝对预测误差为O.10D-5.50D,平均绝对预测误差值为1.56±1.43D。绝对预测误差低于1.0D共32眼,占总眼数52%。绝对预测误差在眼轴≤20 mm及年龄≤2岁患儿中明显增大。眼轴20mm组共计13眼,绝对预测误差为2.75±1.66D；眼轴20mm组共计49眼,绝对预测误差为1.06±0.93D；2组间差异具有统计学意义(P0.01)。年龄≤2岁组共14例24眼,绝对预测误差为2.38±1.65D；年龄2岁组共计23例38眼,绝对预测误差为1.04±0.99D；2组间差别具有统计学意义(P0.01)。I期IOL植入组共11例18眼,绝对预测误差为1.37±1.35D；Ⅱ期行IOL植入组共26例44眼,绝对预测误差为2.03±1.56D；2组间差异无统计学意义(P=0.22)。结论 1、全组植入的IOL度数安全有效。眼轴≤20mm及年龄≤2岁患儿绝对预测误差明显增加。 2、选择儿童IOL植入度数时,需要鉴别计算误差的来源,研究眼球植入晶体后增长速率,设计小儿专用的IOL计算公式。
[Abstract]:objective
Cataract is the leading cause of children worldwide, especially the main cause of childhood blindness in developing countries. The occurrence of cataract early visual acuity infants severe inhibition of development. Early surgical treatment of cataract children. Has been widely recognized. Intraocular lens implantation has become the main means of correcting the refractive status after surgery in children with congenital cataract eye. In the growth stage, the early refractive state. There is a significant change of short axial length, corneal curvature steep, anterior chamber depth, postoperative refractive target is non face state complexity increased IOL. Patients need accurate calculation of IOL degrees, the refractive state expected after the operation, the maximum improve the children's vision. So the accurate calculation of IOL degree, has important significance. In this study, the application of SRK formula for children with congenital cataract lens IOL, postoperative detection yield by retinoscopy The accuracy of the selection of IOL degrees before operation was measured to provide a basis for the selection of IOL degrees in children with congenital cataract.
Method
From September 2008 to September 2010 for congenital cataract extraction and +IOL implantation in 37 cases. The age ranged from 1.6 to 6.8 years old, the average age was 2.9 + 1.3 years. All patients need surgical treatment. With glaucoma before and after surgery were excluded from this study. Before the measurement by 10% chloral hydrate given 1 ml/kg oral or enema. Children sleeping after A (ODM-1000A) measurement of axial. Using SRK II formula, according to the average value of 43.5D in normal human corneal curvature, reference crystal A constant (A=118.0), 2 years of age and children under 20% IOL undercorrection, 2~8 children aged between undercorrection 10%, calculate the IOL power at 2 months after operation for retinoscopy, spherical equivalent refraction measured (spherical equivalent spherical mirror decastyle = /2) were calculated. The expected absolute value of postoperative eye diopter after operation and the actual measured refractive error, namely absolute prediction error (absolute prediction error The difference =| expected postoperative diopter and postoperative diopter measured |). Absolute prediction error is small, indicates that the expected postoperative refractive error is small, the calculation accuracy of IOL is higher. The differences in age, axial length, IOL implantation and IOL calculation accuracy, the difference between groups using U test the P value of 0.05, regarded as significant difference.
Result
1. in 62 eyes, the axis of eye was different from 17.74mm-26.27mm, with an average value of 21.12 + 1.68mm.. The axial length increased with age. In this study, the age of children with axial 20mm is less than 2 years old.
The whole group of 2. absolute prediction error is O.10D-5.50D, the average absolute prediction error is 1.56 + 1.43D. absolute prediction error is less than 1.0D in 32 eyes, the total number of eye 52%. absolute prediction significantly increased at the age of 2 children in error less than 20 mm in the axial and axial age <. 20mm group consisted of 13 eyes, the absolute prediction error is 2.75 + 1.66D; axial 20mm group consisted of 49 eyes, the absolute prediction error was 1.06 + 0.93D; the difference was statistically significant between the 2 groups (P0.01). Older than 2 years of age group, a total of 14 cases of 24 eyes, absolute prediction error is 2.38 + 1.65D; 2 years of age group, a total of 23 cases of 38 eyes, absolute prediction error 1.04 + 0.99D; the difference was statistically significant between the 2 groups (P0.01.I) IOL implantation group were 11 cases of 18 eyes, absolute prediction error is 1.37 + 1.35D; II IOL implantation group, a total of 26 cases of 44 eyes, absolute prediction error is 2.03 + 1.56D; there was no significant difference between the 2 groups (P=0.22).
conclusion
1, the whole group of IOL implantation is safe and effective. The degree of axial 20mm and older than 2 years of age with absolute prediction error increased significantly.
2, when choosing the degree of IOL implantation for children, it is necessary to identify the source of the calculation error, to study the growth rate after the lens implantation, and to design the IOL formula for children.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.66

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