后房型有晶体眼人工晶体植入术矫正散光的临床研究

发布时间：2018-04-11 06:39

本文选题：散光 + 人工晶体　；参考：《安徽医科大学》2010年硕士论文

【摘要】： 背景与目的随着现代社会科学的发展,人们的生活和学习条件以及生活模式的改变,使屈光不正的发病率日益增高。屈光不正是目前世界范围内最常见的眼病。屈光不正的发病率与人类种族、性别、年龄、地区、环境等因素有关。亚洲是公认的屈光不正高发地区,其中,中国和日本发病率最高。有关屈光不正的矫正和治疗也一直是处于不断发展同时又充满挑战的领域。自20世纪中期开始,屈光性人工晶状体手术(refractive intraocular lens surgery)方法不断改善,并逐步应用于临床。屈光性人工晶状体手术的含义是,采用人工晶状体植入的方法,矫正眼的异常屈光状态。它的出现使得不同的年龄层次、不同屈光状态的患者施行个性化治疗方案成为可能。散光型人工晶体(toric intraocular lens,Toric IOL)的概念于1992年首先由Misawa提出,即在人工晶体的光学球面上附加一柱镜。但第一代Toric IOL因旋转稳定性差及大切口本身也可产生散光,导致矫正效果差,未能在临床上得以推广。后房型有晶体眼散光型人工晶体(visian toric implantable collamer lens,TICL)植入术作为一种手术矫治散光的新方法,它不改变原有屈光间质,有更符合眼内生理,屈光矫正范围广,术后视觉症状少,可逆等优越性。本课题主要通过对近视散光患者行TICL植入术,评价其术后矫正效果的准确性、可预测性、稳定性以及手术的安全性和可能存在的风险和并发症,进而揭示其在临床中的应用前景。方法连续收集2007年4月至2009年6月在安徽医科大学第一附属医院和深圳博爱医院行TICL植入术且临床资料完整的近视散光患者57例共100只眼。术前近视度数为(-4.75～-23.00)D,平均为(-11.225±3.920)D,散光度为(1.25～6.5)D,平均为(2.605±0.923)D,眼轴长平均为(27.527±1.653)mm,前房深度平均为(3.270±0.306)mm。术后随访时间分别在术后1天、1周、1月、3月、6月、12月和24月,共2年。主要观察患者手术前后视力、屈光状态、角膜内皮细胞计数、角膜曲率、眼压、前房、人工晶体柱镜轴位和自身晶体等情况。对观察结果进行统计学分析,揭示TICL手术的疗效和风险。结果1、术后6月,患者残余散光度为(0～2.5)D,平均(0.778±0.674)D,矫正效果准确显著。2、其中有35眼随访时间超过2年,术后6月、12月、24月散光度变化在0.5D以内,矫正效果稳定。3、95%眼裸眼视力(uncorrected visual acuity,UCVA)和99%眼最佳矫正视力(best corrected visual acuity,BCVA)均达到或优于术前BCVA,矫正效果的可预测性强。4、术后3月,观察TICL在眼内的旋转,其中旋转大于30°眼占2%,96%眼旋转小于15°,说明TICL在眼内稳定。5、并发症情况:7眼眼压一过性升高,经降眼压治疗,1周内恢复正常。1例2眼眼压持续升高。1例双眼眩光。未发现晶状体浑浊,色素性青光眼病例。结论TICL可提高患者视觉质量,矫正散光效果准确,可预测性强,并具有良好的旋转稳定性。这种新方法的应用开辟了屈光手术新的治疗前景。
[Abstract]:Background and objective with the development of modern social science and the change of people's living and learning conditions and life mode, the incidence of ametropia is increasing day by day.Ametropia is currently the most common eye disease worldwide.The incidence of ametropia is related to human race, sex, age, region, environment and other factors.Asia is recognized as an area with high incidence of ametropia, with China and Japan having the highest incidence.Correction and treatment of ametropia has been a growing and challenging field.Since the middle of the 20th century, refractive intraocular lens surgerymethod has been improved and gradually applied in clinical practice.Refractive intraocular lens surgery means that IOL implantation is used to correct the abnormal refractive state of the eye.It makes possible individualized treatment for patients with different age levels and refractive states.The concept of astigmatic intraocular lensi iol was first proposed by Misawa in 1992, that is to say, a cylindrical mirror is attached to the optical sphere of the intraocular crystal.However, the first generation of Toric IOL can produce astigmatism due to poor rotation stability and large incision itself, which leads to poor correction effect and can not be popularized in clinic.Posterior chamber astigmatism intraocular lens implantation is a new method for correction of astigmatism. It does not change the original refractive stroma. It is more in accordance with intraocular physiology, wide range of refractive correction and less postoperative visual symptoms.Reversible and equal superiority.The purpose of this study was to evaluate the accuracy, predictability, stability, safety, possible risks and complications of TICL implantation in myopic astigmatism patients.The prospect of its application in clinic is revealed.Methods from April 2007 to June 2009, 57 myopic astigmatism patients with complete clinical data received TICL implantation in the first affiliated Hospital of Anhui Medical University and Boai Hospital in Shenzhen.The preoperative myopia degree was -4.75 ~ 23.00 渭 D, the average was -11.225 卤3.920 D., the astigmatism was 1.25 卤6.5d, the average was 2.605 卤0.923 D., the average axial length was 27.527 卤1.653 mm, and the average depth of anterior chamber was 3.270 卤0.306 mm.The follow-up time was 1 week, 1 month, 3 months, 6 months, 12 months and 24 months, respectively.The visual acuity, refractive state, corneal endothelial cell count, corneal curvature, intraocular pressure, anterior chamber, intraocular lens axis and self-lens were observed before and after operation.The results were statistically analyzed to reveal the efficacy and risk of TICL operation.Results 1. Six months after operation, the residual astigmatism of the patients was 0.75 卤0.674D, with an average of 0.778 卤0.674D. The correction effect was significant and accurate. 35 eyes were followed up for more than 2 years, and the astigmatism changed within 0.5D in 6 months, 12 months and 24 months after operation.The corrected effect was stable in 95% of the eyes. The uncorrected visual acuity (UCVA) and the best corrected visual acuity of 99% eyes were up to or superior to those of the preoperative BCVA. The predictive value of the correction effect was strong. 3 months after operation, the rotation of TICL in the eyes was observed.The rotation greater than 30 掳accounted for 2 / 96% of the eyes and the rotation was less than 15 掳, indicating that TICL was stable in the eyes. 5. The complications were transient elevation of IOP in 7 eyes. The IOP in 1 case recovered to normal in 1 week. The IOP continued to increase in 1 case.No lens opacity and pigmented glaucoma were found.Conclusion TICL can improve the visual quality, correct astigmatism, and has good rotation stability.The application of this new method opens up a new prospect for the treatment of refractive surgery.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66

【引证文献】