瞳孔中心定位在多焦点人工晶状体植入术中的应用  

Clinical application of pupil center-marked to multifocal intraocular lenses implantation

作　　者：赵岐[1,2] 李乃洋[1,2] 

机构地区：[1]中山大学附属中山医院眼科中心 [2]中山市人民医院眼科,广东省中山市528403

出　　处：《眼科》2011年第2期90-94,共5页Ophthalmology in China

基　　金：广东省中山市科技计划项目资助(项目编号:20091A063)

摘　　要：目的探讨瞳孔中心定位在多焦点人工晶状体(MFIOL)植入术中的临床应用价值。设计前瞻性病例对照研究。研究对象2009年7月至2010年11月于中山医院眼科中心就诊的年龄相关性白内障患者56例(64眼)。方法根据是否使用瞳孔中心定位将入选病例按随机数字表分为定位组和对照组,每组32眼。定位组使用瞳孔中心定位,在散瞳前根据角膜反光点定位瞳孔中心,术中以中心定位点为参照连续环形撕囊,并使植入的MFIOL中心点与瞳孔中心定位点重合。两组患者常规行超声乳化白内障吸除联合多焦点人工晶状体(IQ ReSTOR+3.0 D,Alcon)植入术。术后随访3个月,检查LogMAR裸眼远视力、最佳矫正远视力、裸眼近视力和最佳矫正近视力。使用Pentacam三维眼前房测量系统采集术眼Scheimpflug图像,采用Image-pro plus 6.0图像分析得出MFIOL的倾斜度和偏心量。并对两组结果进行比较分析。主要指标视力,人工晶状体偏心值、倾斜度。结果术后3个月,定位组的裸眼远视力(0.08±0.08)和裸眼近视力(0.08±0.10)均较对照组(0.13±0.08)、(0.13±0.08)好,差异有统计学意义(t=2.293,P=0.025t;=2.102,P=0.040);定位组的最佳矫正远视力(-0.01±0.04)和最佳矫正近视力(-0.01±0.04)均与对照组(0.01±0.04)、(0.01±0.04)相当,差异无统计学意义(t=1.512,P=0.136t;=1.149,P=0.255)。定位组的MFIOL水平偏心值(0.19±0.09 mm)和倾斜度(2.42°±0.53°)均较对照组(0.24±0.11 mm)、(2.68°±0.47°)小,差异均有统计学意义(t=2.010,P=0.049;t=2.043,P=0.045);定位组的垂直偏心值(0.18±0.07 mm)和倾斜度(2.32°±0.53°)均较对照组(0.22±0.09 mm)、(2.59°±0.47°)小,差异均有统计学意义(t=2.021,P=0.048;t=2.166,P=0.034)。定位组水平和垂直方向上IOL的偏心量和倾斜度均呈线性正相关(r=0.693,P=0.000r;=0.693,P=0.000);对照组水平和垂直方向上IOL的偏心量和倾斜度也均呈线性正相关(r=0.844,P=0.000r;=0.743,P=0.000)。结论瞳�Objective To evaluate the method of pupil center-marked to multifocal intraocular lens （MFIOL） implantation in phaeoemulsification. Design Prospective case control study. Participants Fifty-six patients （64 eyes） with age-related cataract underwent phacoemulsification and MFIOL implantation （IQ ReSTOR ＋3.0 D,Alcon） from July 2009 to November 2010 in Zhongshan Hospital of Sun Yet-sen University. Methods All eyes were randomly assigned to pupil center-marked group and control group based on the use of pupil center-marked. There were 32 eyes in each group. The procedure of pupil center-marked was as following： the center of pupil was marked before pupil dilation according to the corneal reflex. A 5.5 mm central continuous curvilinear capsulorhexis was created centrically referring to marked pupil center. The center of MFIOL was adjusted to coincide with the marked point. All patients underwent phacoemulsification and MFIOL implantation. Patients were followed up for three months. LogMAR uncorrected distance visual acuities （UDVA）, corrected distance visual acuities （CDVA）, uncorrected near visual acuities （UNVA） and distance-corrected near visual aeuities （DCNVA） were observed. Tilt and deeentration of IOL were measured using Scheimphlug system （Pentacam, Oculus） and analyzed with Image-pro plus 6.0 software. The results of two groups were compared. Main Outcome Measures UDVA, CDVA, UNVA, DCNVA, tilt and decentration of IOL. Results The study evaluated 64 eyes of 56 patients. Three months postoperatively UDVA in pupil center-marked group and control group were 0.08±0.08 and 0.13±0.08 （t=2.293,P=0.025）. CDVA were -0.01±0.04 and 0.01±0.04 （t= 1.512, P=0.136）; UNVA were 0.08±0.10 and 0.13±0. 08 （t=2.102, P=0.040） and DCNVA were -0.01±0.04 and 0.01±0.04 （t=1.149, P= 0.255）. The mean MFIOL decentration in two groups was 0.19±0.09 mm and 0.24±0.11 mm （t=2.010, P=0.049） horizontally, 0.18±0.07 mm and 0.22±0.09 mm （t=2.021, P=0.048） vertically, respecti

关 键 词：多焦点人工晶状体 定位 偏心 倾斜 

分 类 号：R779.66[医药卫生—眼科]