儿童白内障患者植入多焦点人工晶体的初步临床效果观察

发布时间：2018-06-14 09:42

本文选题：晶体 + 人工　；参考：《济南大学》2013年硕士论文

【摘要】：目的通过研究儿童白内障患者植入多焦点人工晶体的手术适应证和观察植入术后初期的临床效果，为儿童白内障患者的临床治疗提供参考依据。方法采用前瞻性病例研究收集2011年1月至2013年3月因“先天性白内障”或“发育性白内障”于我院行手术治疗且资料完整的22例27只眼。其中包括男13例，女9例；年龄6-14岁，平均9.5岁。21眼为绕核性白内障，6眼为核性白内障，全部患者行白内障超声乳化吸除联合折叠式人工晶体植入手术治疗。按照植入人工晶体的类型分为多焦点人工晶体组（multifocal intraocular lens,MIOL组）和单焦点人工晶体组（single focus intraocular lens,SIOL组）。MIOL组12例15眼，植入衍射多焦点人工晶体AMO Tecnis ZMB00；SIOL组10例12眼，植入单焦点球面人工晶体Bausch＆Lomb Akreos Adapt。术前均行角膜曲率、角膜散光、眼轴、角膜内皮、瞳孔直径测量，IOL测算，B超、VEP等检查。随访12mon后对比MIOL组和SIOL组的未矫正远、近视力，中间视力、最佳矫正远、近视力，远视矫正度数下近视力，对比度视力、等效球镜、散光、眼轴、瞳孔直径、立体视锐度、伪调节力，脱镜率、发放视觉症状及满意度调查问卷，记录术后并发症。采用SPSS17.0统计软件进行数据分析，两组数据的比较若均符合正态分布采用两个独立样本的t检验，若不符合则采用两个独立样本的非参数检验Mann-Whitney U检验，成组资料的比较采用多个独立样本的非参数检验Kruskal-Wallis H检验，率的比较行Fisher’s卡方检验，均以P0．05为差异有统计学意义。结果 1.术前MIOL组和SIOL组的年龄、视力、眼轴、角膜散光、瞳孔直径、IOL屈光度比较差异均无统计学意义（分别为t=0.00，z=-0.074，t=0.081，t=-0.472，t=-0.458，t=1.296），p0.05（见表2）。性别构成比差异亦无统计学意义，p0.05（见表3）。 2．术后MIOL组和SIOL组的未矫正近视力、中间视力、远视矫正度数下近视力、近附加度数比较差异均有统计学意义（分别为z=-3.725,z=-2.327,z=-2.735,z=-4.431）,p0.05。而未矫正远视力、最佳矫正远视力、最佳矫正近视力均无统计学意义（分别为z=-0.125,t=0.303,z=-1.015）,p0.05。 3．MIOL组和SIOL组患者随着对比度的下降，视力均呈下降趋势；随着背景亮度的下降，视力变化不大。见表5-表8 3.1对MIOL组和SIOL组患者在同一背景亮度下（250cd/m2和25cd/m2）各对比度的视力（100%，25%，10%，5%）进行比较，差异均有统计学意义，p0.05（X2值分别为46.86,34.59,47.38,34.99）。组间两两比较,结果显示差异均无统计学意义，p0.05（分别为t=-0.586，t=-1.649，z=-1.026，z=-1.691，t=-0.625，t=-1.531，z=-0.781，z=-1.222）。见表5，表6 3.2对同一对比度下不同的背景亮度时的视力行组内两两比较，结果显示差异均无统计学意义，p0.05。见表7，表8 4.两组患者的等效球镜、角膜散光、眼轴及瞳孔直径差异均无统计学意义，p0.05。（分别为t=-0.229,z=-1.868,t=-2.021,z=-0.476）见表9 5．两组患者术后未矫正远立体视比较差异无统计学意义（p0.05）,但MIOL组立体视良好者所占的比率（41.7%）比SIOL组（30%）要高。两组患者未矫正近视力和最佳矫正近立体视比较差异有统计学意义（p0.05）。见表10,11 6．多焦点IOL伪调节力平均值为2.50±0.37D，SIOL组的平均值为0.92±0.31D，二者比较差异有统计学意义（t=11.97,p0.05）。 7．MIOL组视远脱镜率为75%，SIOL组为60%，二者比较差异无统计学意义，p0.05。MIOL组视近脱镜率为91.7%，SIOL组为10%，两组之间差异有统计学意义，p0.05。MIOL组完全脱镜率为75%，SIOL组为10%，二者比较差异亦有统计学意义，p0.05。见表12 8．术后12mon行问卷调查评分，其中两组之间的视觉不良症状评分和看远满意度评分比较差异均无统计学意义，，p0.05。而两组之间看近满意度评分比较差异有统计学意义，p0.05。见表13 9. MIOL组的后发性白内障的发生率为20%，低于SIOL组的33%，但二者比较差异并无统计学意义，p0.05。见表14,15 结论儿童白内障患者植入多焦点人工晶体可以获得较好的全程视力，立体视觉更好，脱镜率更高且未出现明显的视觉症状和并发症。因此，对于6-14岁儿童植入多焦点人工晶体或许是个不错的选择。但由于本实验观察例数较少、随访时间较短，远期效果有待于考证。多焦点人工晶体适应证控制较严格,术后需要相当长的学习过程且价格较高，因而限制了在儿童白内障患者中的广泛应用。
[Abstract]:objective
To provide reference basis for the clinical treatment of children with cataract by studying the surgical indications of implantation of multi focal intraocular lens in children with cataract and observing the clinical effect of the early stage after implantation.
Method
A prospective case study was used to collect 22 cases of 27 eyes from January 2011 to March 2013 with "congenital cataract" or "developmental cataract" in our hospital with complete data, including 13 men, 9 women, 6-14 years of age and 9.5 years of.21 eyes with nuclear white barrier and 6 eyes as nuclear cataract. All the patients were in white. Phacoemulsification combined with foldable intraocular lens implantation was performed. According to the types of implanted intraocular lenses, 12 cases (15 eyes) were divided into multi focus intraocular lens group (multifocal intraocular lens, MIOL group) and single focus intraocular lens group (single focus intraocular lens, SIOL group), and the multifocal intraocular lens was implanted into the multifocal intraocular lens. 00; in group SIOL, 10 cases with 12 eyes were implanted with single focus spherical intraocular lens, Ba & Akreos Adapt., before operation, corneal curvature, corneal astigmatism, ocular axis, corneal endothelium, pupil diameter measurement, IOL calculation, B-ultrasound, VEP and other examinations. Follow up 12mon compared the uncorrected distance between the MIOL group and the SIOL group, the near vision, the middle vision, the best correction far, the near vision, and the hyperopia. Near vision, contrast vision, equivalent eyesight, astigmatism, astigmatism, eye axis, pupil diameter, stereoacuity, pseudoracuity, removal of mirror, visual symptoms and satisfaction questionnaires were issued, and postoperative complications were recorded. The data were analyzed by SPSS17.0 software, and the comparison of the two groups of data were in accordance with the normal distribution of two independent samples. T test, if nonconforming, the non parametric test of Mann-Whitney U test with two independent samples, the comparison of group data using multiple independent samples of non parametric test of Kruskal-Wallis H test, the comparison of the rate of Fisher 's chi square test, all with P0.05 as a statistically significant difference.
Result
1. there were no significant differences in age, vision, eye axis, corneal astigmatism, pupil diameter, and IOL diopter in group MIOL and SIOL before operation (t=0.00, z=-0.074, t=0.081, t=-0.472, t=-0.458, t=1.296), P0.05 (see Table 2). There was no significant difference in sex composition ratio, P0.05 (see table 3).
2. uncorrected near vision, middle vision, and hyperopia correction degree of near visual acuity in group MIOL and group SIOL after operation were statistically significant (z=-3.725, z=-2.327, z=-2.735, z=-4.431), p0.05. without correction of far vision, the best correction of far vision, and the best correction of near vision were not statistically significant (z=-0.125, respectively). T=0.303, z=-1.015), p0.05.
In group 3.MIOL and group SIOL, the visual acuity decreased with the decrease of contrast. The visual acuity changed little with the decrease of background brightness. See table 5- Table 8.
3.1 the differences were statistically significant between group MIOL and group SIOL (100%, 25%, 10%, 5%) at the same background brightness (100%, 25%, 10%, 5%). P0.05 (X2 value was 46.86,34.59,47.38,34.99). 22 comparison between groups showed that the difference was not statistically significant, P0.05 (t=-0.586, t=-1.649, z=-1.026, z). =-1.691, t=-0.625, t=-1.531, z=-0.781, z=-1.222). See Table 5, table 6.
3.2 the comparison of 22 groups of visual acuity in the same contrast with different background brightness showed no significant difference. P0.05., see Table 7, table 8.
4. there were no significant differences in the equivalent sphere, corneal astigmatism, ocular axis and pupil diameter in the two groups, and p0.05. (t=-0.229, z=-1.868, t=-2.021, z=-0.476) were found in Table 9.
5. in the two groups, there was no significant difference in postoperative stereopsis (P0.05), but the ratio of stereoscopic vision in group MIOL (41.7%) was higher than that in group SIOL (30%). There was significant difference between the two groups of patients without correction of near vision and the best correction of stereopsis (P0.05). See table 10,11
6. the multifocal IOL pseudo adjustment power averaged 2.50 + 0.37D, and the average value of SIOL group was 0.92 + 0.31D, and the difference between the two groups was statistically significant (t=11.97, P0.05).
The rate of vision removal in group 7.MIOL was 75% and that of group SIOL was 60%. There was no statistical difference between the two groups. The visual angle removal rate of group p0.05.MIOL was 91.7%, group SIOL was 10%, the difference between the two groups was statistically significant, the rate of complete mirror removal in the p0.05.MIOL group was 75%, the group SIOL was 10%, and the two were also statistically significant, p0.05. see table 12.
After 8. 12mon, a questionnaire survey was conducted. There was no significant difference in the scores of visual adverse symptoms between the two groups and the scores of far satisfaction scores. There was a significant difference between the two groups in the two groups, while the difference between the two groups was statistically significant, and that of table 13 was 13.
9. the incidence of posterior capsule opacification in group MIOL was 20%, lower than 33% in group SIOL, but there was no significant difference between the two groups, p0.05. 14,15
conclusion
The implantation of multi focal intraocular lenses for children with cataract can obtain better visual acuity, better stereoscopic vision, higher rate of removal of mirror and no obvious visual symptoms and complications. Therefore, it may be a good choice for 6-14 year old children to implant multi focus intraocular lens. The long-term effect remains to be examined. The multifocal intraocular lens (IOL) indications are strictly controlled, and a long learning process and a higher price are required after the operation, thus limiting the widespread use of cataract in children.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.66

【参考文献】