白内障超声乳化术透明角膜切口构型及波前像差的研究
发布时间：2018-07-14 20:30
【摘要】： 一、不同角度白内障透明角膜切口构型分析 目的 运用前节光相干断层扫描仪(anterior segment optical coherence tomography AS-OCT)探讨采用不同角度构建的3.2mm透明角膜切口构型(clear corneal incision CCI)对白内障切口密闭性的影响。 方法 选择年龄相关性白内障患者63例(73眼),做3.2mmCCI,行白内障超声乳化联合折叠型人工晶体植入术。术前1天、术后1天、1周及1个月应用AS-OCT对角膜切口区进行扫描。切口表面的切线与外口、内口连线的交角作为切口角度,依据切口角度范围的不同分为两组,≤45°为对照组,共32例(38眼)45。为实验组,共31例(35眼)。 结果 (1)对照组和实验组切口角度分别为(31.6±5.4)°和(54.3±5.5)。； (2)术后第1天、1周及1个月两组切口处角膜厚度、切口长度、切口未愈合长度与全长的比例及内口哆开的差异均有统计学意义(P均0.01)； (3)两组后弹力层脱离的差异无统计学意义(P均0.05)； (4)两组切口外口的闭合率均为100%。 结论 (1) AS-OCT是一种非接触式的、有效评估白内障CCI形态改变的方法。 (2)白内障超声乳化术CCI角度大,长度短,将不利于切口(尤其是内口)密闭及愈合。 (3)理想的切口角度有利于构建良好的切口密闭性,降低眼表与前房沟通的可能性,避免眼表细菌进入前房,有助于减少白内障术后眼内炎的发生 二、不同核分级白内障术后透明角膜切口构型分析 目的 应用OCT研究不同核分级白内障超声乳化术后CCI的构型变化及术前核硬度不同对术后切口愈合的影响。 方法 选择年龄相关性白内障患者82例(93眼)做3.2mm CCI,行白内障超声乳化术联合人工晶体植入术。依据Emery和Little晶状体核硬度分级标准：将所有病例分为三组,Ⅱ级核26例(31眼),Ⅲ级核29例(31眼),Ⅳ31例(31眼)。术前1d、术后1d、术后1月及3个月采用AS-OCT扫描全部角膜及切口区域,测量不同区域角膜厚度,记录切口内外口哆开、水疱及后弹力层脱离情况。定量资料进行单项及两因素重复测量的方差分析,定性资料进行χ2检验。 结果 (1)术前术后不同时间点，不同区域(中央角膜、距顶点3mm处上方角膜、距顶点3mm处下方角膜,切口区域角膜)的角膜厚度有统计学差异(F=306.23,288.34,52.17,957.28，P均=0.00)； (2)不同核分级组中央角膜厚度、距顶点3mm处上方角膜厚度、切口区域角膜厚度组间差异有统计学意义(F=3.59,4.43,39.67，P=0.02,0.01,0.00)； (3)术后时间与核硬度之间有明显的交互效应,(F=59.27,11.62,9.05，25.65,P均=0.00)。术后1周,三组上皮水疱、切口内口哆开、内皮水泡的发生率最高,且组间差异有统计学意义(χ2=8.78,8.07，11.82,P=0.00,0.02，0.00)； (4)术后1个月三组间切口内口哆开及内皮水泡的发生率差异有统计学意义(χ2=10.68，15.29，P=0.01,0.02,0.00),术后3月均消退。 (5)本研究发现术后1个月及3个月时切口内口愈合不良1例。 结论 (1)白内障超声乳化术导致不同区域的角膜厚度均有不同程度的增加,以术后1d最显著,其中切口区域的角膜厚度增加最明显,并且术后3个月除了切口区域的水肿未完全消退,其他区域的角膜均发生了可逆性的改变。 (2)不同区域角膜厚度随时间的变化趋势不同,其中角膜中央水肿消退最快,其次为距角膜顶点3mm处下方区域及距顶点3mm上方区域,且这三个区域的角膜水肿均在术后3个月完全消退。 (3)本研究发现了1例Ⅳ级核患者出现切口内口愈合不良,其余切口愈合良好。Ⅲ级核和Ⅳ级核患者术后切口内口哆开,上皮水疱,内皮水疱及后弹力层脱离完全愈合慢于Ⅱ级核。 三、不同位置白内障透明角膜切口构型及角膜波前像差分析 目的 探讨白内障超声乳化术后不同部位透明角膜切口CCI构型及角膜波前像差的变化。 方法 选择年龄相关性白内障患者91例(91只右眼),依据切口位置不同分为两组,颞侧10点位切口组,共46例(46眼),上方12点位切口组,共45例(45眼)。术前1d、术后1d、1个月及3个月分别进行AS-OCT扫描,术后1个月及3个月进行裸眼视力(uncorrected visual acuity，，UCVA)、最佳矫正视力(best corrected visual acuity, BCVA)及角膜波前像差检查。 结果 (1)术后两组切口区域角膜厚度增值、切口角度及切口长度差异均有统计学意义(P均0.05)； (2)术后早期切口区域内口哆开发生率差异均有统计学意义(P均0.05)； (3)术后1d两组上皮水疱、内皮水疱及后弹力层脱离发生率的差异有统计学意义(P均0.05)； (4)两组UCVA、BCVA、散光、慧差及三叶草差异均有统计学意义(P均0.05)。 结论 (1)术后早期,白内障超声乳化术透明角膜颞侧切口较上方切口局部水肿轻,其构型更有利于形成密闭性切口,降低眼内炎的危险因素； (2)术后远期,颞侧切口所致手术源性散光小,角膜波前像差小,视觉质量好,是较理想的手术切口部位。
[Abstract]:Analysis of the configuration of transparent corneal incision at different angles
objective
The effect of 3.2mm transparent corneal incision (clear corneal incision CCI) on the closure of the cataract incision was investigated by anterior segment optical coherence tomography AS-OCT using the anterior segment optical coherence tomography (optical coherence tomography AS-OCT).
Method
63 cases (73 eyes) of patients with age-related cataract (73 eyes) were performed 3.2mmCCI with cataract phacoemulsification combined with foldable intraocular lens implantation. The corneal incision area was scanned by AS-OCT for 1 days before operation, 1 days, 1 weeks and 1 months after operation. The cut angle of the incision surface and the intersection angle of the inner mouth line were used as the incision angle, according to the angle range of the incision. The patients were divided into two groups, with a total of 32 cases (38 eyes) and a total of 32 cases (38 eyes), with a total of 31 cases (35 eyes).
Result
(1) the incision angles of the control group and the experimental group were (31.6 + 5.4) degrees and (54.3 + 5.5) respectively.
(2) the corneal thickness at the first, 1 and 1 months after the operation, the length of the incision, the length of the incision, the proportion of the length of the incision and the total length of the incision and the difference of the inner mouth were statistically significant (P 0.01).
(3) there was no significant difference between the two groups of posterior elastic detachment (P = 0.05).
(4) the closure rate of the two groups of incisional incision was 100%.
conclusion
(1) AS-OCT is a non-contact and effective method to evaluate the morphological changes of CCI in cataract.
(2) cataract phacoemulsification has a large CCI angle and short length, which will not be conducive to airtight and healing of incision (especially internal opening).
(3) the ideal incision angle is beneficial to the construction of good closure of the incision, the possibility of reducing the communication between the eye surface and the anterior chamber, to avoid the entry of ocular surface bacteria into the anterior chamber, and to reduce the incidence of endophthalmitis after cataract surgery.
Two. Analysis of clear corneal incision configuration after cataract surgery with different nuclear grades.
objective
OCT was used to study the changes of CCI configuration after different phacoemulsification and the effect of different preoperative nuclear hardness on wound healing.
Method
82 cases (93 eyes) of age related cataract were selected to do 3.2mm CCI and cataract phacoemulsification combined with intraocular lens implantation. According to the standard of Emery and Little lens nuclear hardness classification, all cases were divided into three groups, 26 cases (31 eyes), 29 cases of grade III (31 eyes), 31 cases (31 eyes). Preoperative 1D, postoperative 1D, postoperative January and 3 months postoperatively. All corneal and incisional regions were scanned with AS-OCT. The corneal thickness in different regions was measured, the opening of the incision, the blister and the detachment of the posterior elastic layer were recorded. The quantitative data were analyzed by the single and two factors repeated measurements, and the qualitative data were tested by the chi 2 test.
Result
(1) there were significant differences in corneal thickness between different regions (central cornea, upper cornea at the apex 3mm, lower cornea at the apex 3mm, and cornea of the incision area) before and after the operation (F=306.23288.34,52.17957.28, P =0.00).
(2) the thickness of the central cornea, the thickness of the corneal thickness above the apex 3mm and the corneal thickness in the incision area were statistically significant (F=3.59,4.43,39.67, P=0.02,0.01,0.00).
(3) there was an obvious interaction effect between the postoperative time and the nuclear hardness (F=59.27,11.62,9.05,25.65, P =0.00). 1 weeks after the operation, the three groups of epithelial blister, the incision in the mouth opened, the incidence of endothelial vesicles was the highest, and there was a statistically significant difference between the groups (x 2=8.78,8.07,11.82, P= 0.00,0.02,0.00).
(4) 1 months after operation, there was a significant difference in the incidence of incision opening and endothelia blisters between the three groups (2=10.68,15.29, P=0.01,0.02,0.00), and all of them subsided in March.
(5) there were 1 cases of poor healing of incisions at 1 and 3 months after operation.
conclusion
(1) cataract phacoemulsification resulted in a different degree of corneal thickness in different regions, with the most significant postoperative 1D, the most obvious increase in the corneal thickness in the incision area, and 3 months after the operation, the edema in the incision area was not completely subsided, and the cornea of the other regions had a reversible change.
(2) the variation trend of corneal thickness in different regions was different with time, in which the central corneal edema subsided most quickly, followed by the region below the corneal vertex 3mm and the area above the apex of 3mm, and the corneal edema in these three regions all subsided in 3 months after the operation.
(3) in this study, 1 cases of grade IV Nuclear patients were found to have poor healing in the incision, and the rest of the incision healed well. The incision of the incision in the third class nucleus and grade IV nucleus, the epithelial blister, the endothelial blister, and the complete healing of the posterior elastic layer were slower than the class II nucleus.
Three, the different types of transparent corneal incision configuration and corneal wavefront aberration in different locations.
objective
Objective to investigate the changes of CCI configuration and corneal wavefront aberration in different parts of clear corneal incision after phacoemulsification.
Method
91 cases (91 right eyes) of patients with age-related cataract were divided into two groups according to the location of the incision, 10 point incision in the temporal side, 46 cases (46 eyes), 12 points in the incision group, and 45 cases (45 eyes). The preoperative 1D, 1D, 1 months and 3 months after the operation were carried out by AS-OCT scanning respectively, and the naked eye (uncorrected visual acuity) was carried out 1 months and 3 months after the operation. (UCVA), best corrected visual acuity (BCVA) and corneal wavefront aberration test.
Result
(1) there were significant differences in corneal thickness, incision angle and incision length between the two groups (P 0.05).
(2) there were significant differences in the incidence of mouth opening in the early incision area (P = 0.05).
(3) there was a significant difference in the incidence of epithelial blister, endothelial blister and posterior elastic detachment between group 1D and group two (P 0.05).
(4) there were significant differences in two groups of UCVA, BCVA, astigmatism, coma and Trifolium (P 0.05).
conclusion
(1) early postoperative, cataract phacoemulsification, transparent corneal temporal incision is less local edema than the upper incision, and its configuration is more conducive to the formation of closed incision and reduce the risk factors of endophthalmitis.
(2) long term postoperative, temporal astigmatism resulted in low surgical astigmatism, small wavefront aberration and good visual quality.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66
本文编号：2122862
[Abstract]:Analysis of the configuration of transparent corneal incision at different angles
objective
The effect of 3.2mm transparent corneal incision (clear corneal incision CCI) on the closure of the cataract incision was investigated by anterior segment optical coherence tomography AS-OCT using the anterior segment optical coherence tomography (optical coherence tomography AS-OCT).
Method
63 cases (73 eyes) of patients with age-related cataract (73 eyes) were performed 3.2mmCCI with cataract phacoemulsification combined with foldable intraocular lens implantation. The corneal incision area was scanned by AS-OCT for 1 days before operation, 1 days, 1 weeks and 1 months after operation. The cut angle of the incision surface and the intersection angle of the inner mouth line were used as the incision angle, according to the angle range of the incision. The patients were divided into two groups, with a total of 32 cases (38 eyes) and a total of 32 cases (38 eyes), with a total of 31 cases (35 eyes).
Result
(1) the incision angles of the control group and the experimental group were (31.6 + 5.4) degrees and (54.3 + 5.5) respectively.
(2) the corneal thickness at the first, 1 and 1 months after the operation, the length of the incision, the length of the incision, the proportion of the length of the incision and the total length of the incision and the difference of the inner mouth were statistically significant (P 0.01).
(3) there was no significant difference between the two groups of posterior elastic detachment (P = 0.05).
(4) the closure rate of the two groups of incisional incision was 100%.
conclusion
(1) AS-OCT is a non-contact and effective method to evaluate the morphological changes of CCI in cataract.
(2) cataract phacoemulsification has a large CCI angle and short length, which will not be conducive to airtight and healing of incision (especially internal opening).
(3) the ideal incision angle is beneficial to the construction of good closure of the incision, the possibility of reducing the communication between the eye surface and the anterior chamber, to avoid the entry of ocular surface bacteria into the anterior chamber, and to reduce the incidence of endophthalmitis after cataract surgery.
Two. Analysis of clear corneal incision configuration after cataract surgery with different nuclear grades.
objective
OCT was used to study the changes of CCI configuration after different phacoemulsification and the effect of different preoperative nuclear hardness on wound healing.
Method
82 cases (93 eyes) of age related cataract were selected to do 3.2mm CCI and cataract phacoemulsification combined with intraocular lens implantation. According to the standard of Emery and Little lens nuclear hardness classification, all cases were divided into three groups, 26 cases (31 eyes), 29 cases of grade III (31 eyes), 31 cases (31 eyes). Preoperative 1D, postoperative 1D, postoperative January and 3 months postoperatively. All corneal and incisional regions were scanned with AS-OCT. The corneal thickness in different regions was measured, the opening of the incision, the blister and the detachment of the posterior elastic layer were recorded. The quantitative data were analyzed by the single and two factors repeated measurements, and the qualitative data were tested by the chi 2 test.
Result
(1) there were significant differences in corneal thickness between different regions (central cornea, upper cornea at the apex 3mm, lower cornea at the apex 3mm, and cornea of the incision area) before and after the operation (F=306.23288.34,52.17957.28, P =0.00).
(2) the thickness of the central cornea, the thickness of the corneal thickness above the apex 3mm and the corneal thickness in the incision area were statistically significant (F=3.59,4.43,39.67, P=0.02,0.01,0.00).
(3) there was an obvious interaction effect between the postoperative time and the nuclear hardness (F=59.27,11.62,9.05,25.65, P =0.00). 1 weeks after the operation, the three groups of epithelial blister, the incision in the mouth opened, the incidence of endothelial vesicles was the highest, and there was a statistically significant difference between the groups (x 2=8.78,8.07,11.82, P= 0.00,0.02,0.00).
(4) 1 months after operation, there was a significant difference in the incidence of incision opening and endothelia blisters between the three groups (2=10.68,15.29, P=0.01,0.02,0.00), and all of them subsided in March.
(5) there were 1 cases of poor healing of incisions at 1 and 3 months after operation.
conclusion
(1) cataract phacoemulsification resulted in a different degree of corneal thickness in different regions, with the most significant postoperative 1D, the most obvious increase in the corneal thickness in the incision area, and 3 months after the operation, the edema in the incision area was not completely subsided, and the cornea of the other regions had a reversible change.
(2) the variation trend of corneal thickness in different regions was different with time, in which the central corneal edema subsided most quickly, followed by the region below the corneal vertex 3mm and the area above the apex of 3mm, and the corneal edema in these three regions all subsided in 3 months after the operation.
(3) in this study, 1 cases of grade IV Nuclear patients were found to have poor healing in the incision, and the rest of the incision healed well. The incision of the incision in the third class nucleus and grade IV nucleus, the epithelial blister, the endothelial blister, and the complete healing of the posterior elastic layer were slower than the class II nucleus.
Three, the different types of transparent corneal incision configuration and corneal wavefront aberration in different locations.
objective
Objective to investigate the changes of CCI configuration and corneal wavefront aberration in different parts of clear corneal incision after phacoemulsification.
Method
91 cases (91 right eyes) of patients with age-related cataract were divided into two groups according to the location of the incision, 10 point incision in the temporal side, 46 cases (46 eyes), 12 points in the incision group, and 45 cases (45 eyes). The preoperative 1D, 1D, 1 months and 3 months after the operation were carried out by AS-OCT scanning respectively, and the naked eye (uncorrected visual acuity) was carried out 1 months and 3 months after the operation. (UCVA), best corrected visual acuity (BCVA) and corneal wavefront aberration test.
Result
(1) there were significant differences in corneal thickness, incision angle and incision length between the two groups (P 0.05).
(2) there were significant differences in the incidence of mouth opening in the early incision area (P = 0.05).
(3) there was a significant difference in the incidence of epithelial blister, endothelial blister and posterior elastic detachment between group 1D and group two (P 0.05).
(4) there were significant differences in two groups of UCVA, BCVA, astigmatism, coma and Trifolium (P 0.05).
conclusion
(1) early postoperative, cataract phacoemulsification, transparent corneal temporal incision is less local edema than the upper incision, and its configuration is more conducive to the formation of closed incision and reduce the risk factors of endophthalmitis.
(2) long term postoperative, temporal astigmatism resulted in low surgical astigmatism, small wavefront aberration and good visual quality.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.66
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