玻璃体切除联合白内障术后人工晶状体稳定性和屈光状态的临床研究

发布时间：2018-06-26 14:07

本文选题：人工晶状体 + 偏心　；参考：《天津医科大学》2011年硕士论文

【摘要】：目的： 1.比较三种不同材料和设计的人工晶状体应用于玻璃体切除手术联合白内障超声乳化人工晶状体植入术(联合手术)术后囊袋内的稳定性。 2.比较联合手术术前预测的等效球镜度数(预测值)与术后实际的等效球镜度数(实际值)的大小,比较单纯白内障超声乳化人工晶状体植入术与联合手术屈光状态变化(实际值与预测值之差)大小,获得联合手术术后屈光状态变化的规律。方法： 1.选取2009年3月—2010年3月期间于我院接受联合手术的52例患者58眼,根据植入不同的人工晶状体分为三组,四襻式亲水丙烯酸酯晶状体22眼(四襻亲水组),两襻式亲水丙烯酸酯晶状体18眼(两襻亲水组),两襻式疏水丙烯酸酯晶状体18眼(两襻疏水组),术后6个月行眼部基本检查,利用Pentacam三维眼前段分析仪检测人工晶状体的偏心值和倾斜角度。 2.选取同期于我院接受单纯白内障手术的30例患者(50眼)和接受联合手术的患者44例(48眼),分别为单纯组和联合组。根据术中玻璃体腔填充物的不同,联合组又分为平衡盐溶液组和气体组。术前通过测量眼轴长度和角膜曲率计算植入的人工晶状体度数。记录单纯组、平衡盐溶液组、气体组术后6个月的眼轴长度,角膜曲率及实际值,得出各组实际值与预测值的差异。分别比较联合组与单纯组、联合手术各组之间的屈光状态变化差异的大小,分析屈光状态变化的规律与影响因素。结果： 1.四襻亲水组偏心值为(0.13±0.07)mm,两襻亲水组为(0.15±0.08)mm,两襻疏水组为(0.16±0.11)mm,三组偏心值比较差异无统计学意义(P=0.668)；四襻亲水组倾斜角度为(2.29±1.49)度,两襻亲水组为(4.00±1.25)度,两襻疏水组为(4.36±1.78)度,三组倾斜角度比较差异具有统计学意义(P=0.03)；倾斜角度的两两比较中,四襻亲水组与两襻亲水组比较差异有统计学意义(P=0.011),四襻亲水组与两襻疏水组比较差异有统计学意义(P=0.001) 2.联合组术前平均预测值为(-0.1±0.42)D,术后六个月平均实际值为(-1.0±1.1)D,两者之间差异具有统计学意义(t=6.687,P0.05),单纯组和联合组手术后屈光状态平均变化值分别为(0.13±0.53)D和(-0.93±0.92)D,两者比较差异具有统计学意义(t=-3.792,P0.05)；平衡盐溶液组和气体组之间屈光状态平均变化值分别为(-0.76±0.89)和(-1.19±0.94)D,两组比较,差异无统计学意义(t=-1.530,P0.05)。结论： 1.三种不同材料和设计的人工晶状体在联合手术中的应用均较安全和有效,未见明显的偏心和移位,囊带稳定性较好。 2.材料对联合术后人工状晶体位置的影响较小 3.襻的设计可能对联合术后人工状晶体倾斜角度具有一定的影响。 4.联合手术术后眼轴长度变长,可能与玻璃体的切除、高眼压和膨胀气体的张力有关。 5.单纯白内障手术预测值较准确,联合手术术后实际值较预测值产生近视偏移。 6.玻璃体腔填充气体对屈光状态和眼轴长度影响较大。 7.联合手术植入的人工晶状体度数应略偏远视,以抵消近视偏移所致的屈光状态变化。
[Abstract]:Objective:
1. compared the stability of three different materials and designed intraocular lenses in the pouches after vitrectomy combined with cataract phacoemulsification and intraocular lens implantation (combined operation).
2. compare the size of the equivalent spherical mirror degree (predicted value) before the combined operation and the actual value of the postoperative equivalent sphere (actual value), compare the size of the single cataract phacoemulsification IOL implantation and the change of the combined operation diopter (the difference between the actual value and the predicted value), and obtain the change of the refractive state after the combined operation.
Method:
1. to select 58 eyes of 52 patients undergoing joint operation in our hospital from March 2009 to March 2010. According to the implantation of different intraocular lenses, there were three groups, four loop hydrophilic acrylate lens 22 eyes (four loop hydrophilic group), two loop hydrophilic acrylate lens 18 eyes (two loop hydrophilic group), two loop hydrophobic acrylate lens 18 eyes (two). 6 months after the operation, the basic examination of the eye was performed. The Pentacam 3D eye segment analyzer was used to detect the eccentricity and tilt angle of the intraocular lens.
2. a total of 30 patients (50 eyes) and 44 patients receiving combined surgery (48 eyes) were selected in our hospital during the same period. The combination group was divided into the balance salt solution group and the gas group according to the different glass cavity filling material during the operation. Intraocular lens degree. Record simple group, balance salt solution group, eye axis length, corneal curvature and actual value of 6 months after gas group operation, and get the difference between the actual value of each group and the predicted value. Compare the difference between the combined group and the simple group, the difference of the diopter state between the combined group and the group, and analyze the law and shadow of the diopter change. Sound factors.
Result:
The eccentricity of the 1. four loop hydrophilic group was (0.13 + 0.07) mm, the two loop hydrophilic group was (0.15 + 0.08) mm, and the two loop hydrophobic group was (0.16 + 0.11) mm, and the eccentric value of the three group was not statistically significant (P=0.668); the hydrophilic group of four loop was (2.29 +) degrees, the hydrophobicity group of the loop loop was (0.15) degrees, and the slope angle was inclined. The difference was statistically significant (P=0.03); in the 22 comparison of the angle of tilt, the difference between the four loop hydrophilic group and the two loop hydrophilic group was statistically significant (P=0.011). The difference between the four loop hydrophilic group and the two loop hydrophobicity group was statistically significant (P=0.001).
The average predictive value of the 2. group was (-0.1 + 0.42) D, and the average actual value was (-1.0 + 1.1) D after the 6 months of operation. The difference between the two groups was statistically significant (t=6.687, P0.05). The average changes of the refractive state in the simple group and the combined group were (0.13 + 0.53) D and (-0.93 + 0.92) D respectively, and the difference was statistically significant (t=-3.792, P0.). 05): the average variation of diopter between the balanced salt solution group and the gas group was (-0.76 + 0.89) and (-1.19 0.94) D respectively. The difference between the two groups was not statistically significant (t=-1.530, P0.05).
Conclusion:
1. the application of three different materials and designed intraocular lenses in combined surgery is safe and effective. There is no obvious eccentricity and displacement, and the stability of the capsule is good.
2. the effect of material on the position of artificial lens after combined operation is small.
The design of the 3. loop may have a certain effect on the tilt angle of artificial lens after combined operation.
4. longer axial length after combined surgery may be related to vitrectomy, high intraocular pressure and tension of dilated gas.
5. the predictive value of simple cataract surgery is more accurate, and the actual value after combined surgery is nearer to the predicted value than that of the predicted value.
6. vitreous cavity filled gas has great influence on refractive status and axial length.
7. the degree of intraocular lens implantation during combined surgery should be slightly remote to offset the refractive changes caused by myopic shift.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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