频域光学相干断层扫描观察改良YAMANE式后房型人工晶状体巩膜固定术的临床疗效  

Clinical Outcomes of the Scleral Fixation of Posterior Chamber Intraocular Lens using the Modified Yamane’s Technique: a Swept-source Optical Coherence Tomography Study

作　　者：姜惠 陈浩[1] 谭舟利 邹明[1] 吕仲平[1] 范玮[1] JIANG Hui;CHEN Hao;TAN Zhou-li;ZOU Ming;LüZhong-ping;FAN We(Department of Ophthalmology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院眼科,成都610041

出　　处：《四川大学学报（医学版）》2020年第6期859-865,共7页Journal of Sichuan University(Medical Sciences)

摘　　要：目的 结合频域光学相干断层扫描(swept-source optical coherence tomography,SS-OCT),观察改良YAMANE式后房型人工晶状体巩膜固定术(SF-PCIOL)的术后效果、安全性及并发症.方法 采用连续前瞻性病例自身前后对照进行研究.选取2017年12月-2019年11月于四川大学华西医院眼科行改良YAMANE式SF-PCIOL手术的患者.患者行常规白内障术前检查,包括IOL master测量眼球参数,SRK/T公式计算适合的人工晶状体(intraocular lens,IOL)屈光度等.术后第1天测量裸眼视力(uncorrected distance visual acuity,UDVA)、眼压,术后1周、1个月、3个月及6个月以后定期测量患者UDVA、最佳矫正视力(best corrected distance visual acuity,BCDVA)、等效球镜度数(SE)、眼压及角膜内皮细胞密度,记录手术并发症.SS-OCT测量IOL光学部倾斜度及袢在巩膜隧道内固定对称性.结果 本研究共纳入20例患者(20只眼),年龄(55.10±16.24)岁.术后平均随访时间(7.20±6.56)个月(3~26个月).所有患者术后UDVA(0.48±0.50)LogMAR,较术前(1.70±0.38)LogMAR提高(P=0.001).术后BCDVA与术前相比,差异无统计学意义(P=0.08),分别为(0.32±0.48)LogMAR、(0.44±0.50)LogMAR.术后SE(-0.53±0.86)D,屈光误差(0.27±0.82)D.SS-OCT检查17例患者.SS-OCT测得患眼术后前房深度(4.39±0.29)mm,IOL倾斜度(3.28±3.00)°.垂直与水平方位IOL倾斜度比较,差异无统计学意义(P=0.326).IOL倾斜度与术后球镜、柱镜度数无明显相关性(P=0.532,P=0.241).鼻侧与颞侧IOL袢固定于巩膜隧道内长度(HL)分别为(2.24±0.20)mm、(2.17±0.23)mm,差异无统计学意义(P=0.193).鼻侧与颞侧袢末端与巩膜突之间距离(HD)分别为(1.58±0.07)mm、(1.66±0.08)mm,差异无统计学意义(P=0.338).在术后1周、术后1个月、术后3个月三个时间点,跟踪测量10例患者IOL袢的位置,测量并记录两侧袢在隧道内固定长度(鼻侧:HL-N,颞侧:HL-T),袢末端与巩膜突距离(鼻侧:HD-N,颞侧:HD-T).HL-N、HL-T、HD-N、HD-T在术后3个不同�Objective To observe the postoperative outcomes of the scleral fixation of posterior chamber intraocular lens(SF-PCIOL) using the modified Yamane’s technique with the aid of swept-source optical coherence tomography(SS-OCT). Methods Prospective observational case series. This study involved 20 patients who underwent SF-PCIOL with the modified Yamane’s technique, from December 2017 to November 2019. All patients had routine preoperative examinations, including biometric measurement by IOL master, measurements of uncorrected distance visual acuity(UDVA) and best corrected distance visual acuity(BCDVA). The SRK/T formula was used to calculate the power of intraocular lens(IOL). After the surgery, UDVA and intraocular pressure were evaluated for 1 d, UDVA, BCDVA,spherical equivalent(SE) and corneal endothelial cell density were measured for 1 week, 1 month, 3 and 6 months,respectively. The IOL tilt and the symmetry of hepatitis in the scleral tunnel were measured by SS-OCT. Results The mean follow-up duration was(7.20±6.56) months(range, 3-26 months). The mean preoperative UDVA was(1.70±0.38)LogMAR, and it improved to(0.48±0.50) LogMAR(P=0.001). There was no statistically significant difference between the pre-and post-operative BCDVA, i.e.(0.44±0.50) LogMAR and(0.32±0.48) LogMAR, respectively(P=0.08). The mean spherical equivalent was(-0.53±0.86) diopter(D) and the postoperative refractive error was(0.27±0.82) D. Seventeen patients underwent SS-OCT examinations. The mean IOL tilt was(3.28±3.00)°. There was no significant difference between the horizontal and vertical tilt(P=0.326). The IOL tilt did not show a significant correlation with spherical and cylindrical refractive error(P=0.532, P=0.241). There was no statistically significant difference in the HL(the length of haptics fixed in the scleral tunnel) of nasal and temporal haptic, which were(2.24±0.20) mm and(2.17±0.23) mm,respectively(P=0.193). And there were no statistically significant differences between the HD(the distance between the cente

关 键 词：白内障手术 后房型人工晶状体巩膜固定术 频域光学相干断层扫描 

分 类 号：R779.6[医药卫生—眼科]