非球面人工晶状体应用于外伤性白内障术后视觉质量的临床观察

发布时间：2018-05-10 17:49

本文选题：外伤性白内障 + 非球面人工晶状体　；参考：《郑州大学》2011年硕士论文

【摘要】：目的观察零球差非球面人工晶状体应用于外伤性白内障术后的视觉质量。资料和方法选取我院外伤性白内障患者60例(60眼),其中角膜穿孔伤52例(52眼),钝挫伤8例(8眼),入选标准：患者年龄8-30周岁；散光度数在3D以内；角膜伤口或瘢痕位于周边部；虹膜损伤而致大瞳孔、瞳孔变形或移位；角膜内皮计数在1000个/mm2以上；后囊膜完整或者破损较轻人工晶状体可囊袋内或睫状沟固位而不需要缝线固定；术中术后均未出现并发症。排除标准：角膜伤口或瘢痕位于瞳孔区或者伤口较大,愈合后瘢痕明显,对视力有严重影响者；术前存在玻璃体内异物、视网膜脱离以及裂孔、视神经视网膜挫伤等情况明显影响视功能的恢复；有青光眼、葡萄膜炎、糖尿病、自身免疫性疾病病史者。所选患者随机分成两组,30例(30眼)植入零球差非球面人工晶状体(Akreos AO)作为实验组,30例(30眼)植入传统球面人工晶状体(Akreos adapt)作为对照组,所有手术均由同一高年资医师完成,手术过程顺利,术中术后无并发症。术后3个月、6个月对比观察两组患者的裸眼视力(uncorrected visual acuity, UCVA)、最佳矫正视力(best corrected visual acuity, BCVA)、立体视觉、对比敏感度(contrast sensitivity, CS),并对患者生存质量满意度进行问卷调查。采用SPSS 17.0统计学软件进行统计分析,两组术前一般情况比较采用卡方检验,术后视力比较采用Kruskal Wallis检验,对比敏感度和立体视觉比较均采用Wilcoxon秩和检验,取P0.05为检验水准,表示差异具有统计学意义。结果术后3个月、6个月两组患者裸眼视力、最佳矫正视力相比较差异均无统计学意义(P0.05)；术后6个月实验组患者远近立体视觉均优于对照组,但两组相比较差异均无统计学意义(P0.05)；术后6个月实验组各空间频率对比敏感度均高于对照组,特别是眩光对比敏感度,实验组明显优于对照组,两组相比较差异均有统计学意义(P0.05)；问卷调查显示,实验组术后24例较满意,满意度高达80%,对照组16例较满意,满意度为53.3%。结论1.零球差非球面人工晶状体应用于外伤性白内障,其术后的视觉质量优于传统的球面人工晶状体。2.对于角膜瘢痕较小且位于周边、晶状体囊袋或后囊环相对完整、视网膜功能良好的外伤性白内障患者,可植入零球差非球面人工晶状体,这样就可以利用其光学特性,最大限度地保存和提高患者外伤后的视觉质量,同时也提高了患者术后的生存质量。
[Abstract]:Objective to observe the visual quality of zero spherical aspherical intraocular lens in traumatic cataract surgery. Materials and methods 60 cases of traumatic cataract in our hospital were selected, including 52 cases of corneal perforation injury (52 eyes) and 8 cases of blunt contusion (8 eyes). The inclusion criteria were: age 8-30 years, astigmatism within 3D, corneal wound or scar located in peripheral part; Due to iris injury, the pupil was deformed or shifted; the corneal endothelium was more than 1000 / mm2; the complete posterior capsule or light intraocular lens could be retained in the capsule or ciliary sulcus without suture fixation. No complications occurred during and after operation. Exclusion criteria: the corneal wound or scar is located in the pupil area or the wound is larger, the scar is obvious after healing, which has serious influence on visual acuity; there are intravitreous foreign bodies, retinal detachment and rupture before operation, The optic nerve and retina contusion obviously affected the recovery of visual function in patients with glaucoma, uveitis, diabetes mellitus and autoimmune diseases. The selected patients were randomly divided into two groups: 30 patients (30 eyes) were divided into two groups (30 cases) were divided into two groups: (1) A group of 30 cases (30 eyes) were implanted with zero spherical aberration aspheric intraocular lens (Akreos AOL) (30 cases) were implanted with traditional spherical intraocular lens (Akreos adapt) as control group. The procedure was smooth and there were no complications after operation. At 3 months and 6 months after operation, the uncorrected visual acuity, UCVA, best corrected visual acuity, BCVAn, stereoscopic vision, contrast sensitivity, CSA were compared between the two groups, and the satisfaction of the patients with quality of life was investigated by questionnaire. Statistical software SPSS 17.0 was used for statistical analysis. The general situation of the two groups was compared by chi-square test before operation, Kruskal Wallis test was used for postoperative visual acuity comparison, Wilcoxon rank sum test was used for contrast sensitivity and stereoscopic vision comparison, and P0.05 was taken as test level. The difference is statistically significant. Results there was no significant difference in uncorrected visual acuity and best corrected visual acuity between the two groups at 3 months and 6 months after operation (P 0.05), and the distance and near stereo vision in the experimental group was better than that in the control group at 6 months after operation. The spatial frequency contrast sensitivity of the experimental group was higher than that of the control group 6 months after operation, especially the glare contrast sensitivity, and the experimental group was obviously superior to the control group. The questionnaire survey showed that 24 cases in the experimental group were satisfied and the satisfaction was as high as 80 cases, while 16 cases in the control group were satisfactory, and the satisfaction degree was 53.3%. Conclusion 1. Zero spherical aberration aspherical intraocular lens was used in traumatic cataract, and its visual quality was better than that of traditional spherical intraocular lens. 2. For traumatic cataract patients whose corneal scar is small and located in the periphery, the lens capsule or posterior capsule is relatively intact, and the retina functions well, the zero-spherical aspheric intraocular lens can be implanted, so that its optical properties can be utilized. The visual quality of patients after trauma is preserved and improved to the maximum extent, and the quality of life after operation is also improved.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.66

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