有晶体眼人工晶状体植入术后视疲劳症状及影响因素  

Outcomes of asthenopia after implantable collamer lens implantation and its related factors

作　　者：陈海婷[1] 刘逾[1] 张新桥 李幸 CHEN Haiting;LIU Yu;ZHANG Xinqiao;LI Xing(Department of Ophthalmology,Cangzhou Central Hospital,Cangzhou Hebei 061000,China)

机构地区：[1]沧州市中心医院眼一科,河北沧州061000

出　　处：《眼科学报》2022年第8期620-626,共7页Eye Science

摘　　要：目的:评估屈光不正患者有晶体眼后房型人工晶体(implantable collamer lens,ICL)植入术后视疲劳症状及调节集合功能、眼表、像差的变化,并探讨其对视疲劳症状的影响。方法:前瞻性病例观察分析。连续收集在沧州市中心医院行ICL手术并完成3个月随访的患者,测定术前、术后1周、1个月、3个月时的视疲劳评分、调节幅度(amplitude of accommodation,AA)、正相对调节和负相对调节(positive/negative relative accommodation,PRA/NRA)、调节灵敏度(accommodative facility,AF)、调节性集合(accommodative convergence,AC)与调节(accommodation,A)比率(AC/A),Schirmer实验、非侵入性泪膜破裂时间(noninvasive breakup time,NBUT)及高阶像差(higher order aberration,HOA),进行统计学分析。结果:ICL术后第1周视疲劳症状较术前明显加重,随时间推移逐渐减轻,术后1个月仍高于术前,术后3个月时恢复。AA术后1周时较术前降低,术后1个月、3个月时明显高于术前;AF术后1周时较术前下降,术后1个月比术前水平稍好,3个月时明显高于术前;PRA、NRA无明显变化;AC/A术后1周时较术前下降,术后1个月回复到术前水平,术后3个月较术前提高。术后1周、1个月及3个月的NBUT值均较术前明显下降,术后1周时最低;Schiermer值术后1周时轻度下降,术后1个月、3个月时基本恢复。术后的总HOA均较术前有所增加,但各个时间点之间无明显变化。相关性分析显示ICL术后AF越差、NBUT越低,视疲劳症状越重。结论:ICL术后视疲劳症状一过性加重,AF和NBUT是影响视疲劳变化的重要因素。Objective:To evaluate the changes of visual fatigue symptoms,accommodative functions,ocular surface conditions,and high-order aberrations(HOA)after implantation of implantable collamer lens(ICL),and to explore their effects on asthenopia.Methods:It was a prospective observational case series.Patients with ametropia who underwent ICL surgeries and completed 3-month follow-up in our hospital were enrolled.Asthenopia scores,amplitude of accommodation(AA),positive/negative relative accommodation(PRA/NRA),accommodative facility(AF),the ratio of accommodative convergence and accommodation(AC/A),Schirmer test,non-invasive breakup time(NBUT),and HOA were examined before surgeries and at 1 week,1 month and 3 months after surgeries,then statistically analyzed.Results:Symptoms of asthenopia were significantly worse at 1 week after ICL surgeries than those before surgeries,but increased gradually as time went by,eventually recovered at 3 months postoperatively.Among regulatory indicators,AA decreased 1 week postoperatively,but was significantly higher at 1 and 3 months after surgeries;AF was lower 1 week after surgery than baseline,slightly better at 1 month postoperatively,and significantly higher at 3 months postoperatively;PRA and NRA had no significant change;AC/A decreased 1 week after surgeries,returned to the baseline at 1 month postoperatively,and increased 3 months postoperatively.Tears and meibomian gland function index:NBUT values at 1 week,1 month and 3 months after surgeries were significantly decreased compared with those before surgeries,and NBUT at 1 week postoperatively was the lowest;Schiermer values had a slight decrease at 1 week after surgeries,and basically recovered at 1 and 3 months after surgeries.HOA after surgeries were increased compared with those before surgeries,but there was no significant change between each time point.Correlation analysis showed that the lower AF and NBUT after ICL surgeries,the more severe the asthenopia symptoms.Conclusion:The symptoms of asthenopia aggravated transiently

关 键 词：有晶体眼人工晶状体 屈光不正 视疲劳 调节 干眼 

分 类 号：R779.6[医药卫生—眼科]