术中OCT导航显微镜在成熟期白内障术中的应用  

Application of intraoperative OCT navigation microscope in mature cataract surgery

作　　者：谢娇 胡志广 燕涛 Xie Jiao;Hu Zhiguang;Yan Tao(Wuhan Bright Eye Gospital,Wuhan 430000,China;Xiantao Aipu Eye Hospital,Xiantao 433000,China)

机构地区：[1]武汉普瑞眼科医院,430000 [2]仙桃爱埔眼科医院

出　　处：《临床眼科杂志》2022年第5期408-412,共5页Journal of Clinical Ophthalmology

摘　　要：目的探讨术中相干光层析成像术(OCT)导航显微镜(蔡司RESCAN700,简称iOCT)在成熟期白内障摘除术中辅助人工晶状体选择的应用价值。方法分析2019年8月至2021年8月在本院眼科行白内障超声乳化摘除联合人工晶状体植入手术的成熟期白内障患者156例(156只眼),所有患者均使用iOCT在白内障超声乳化结束后观察黄斑区视网膜情况,根据观察结果黄斑区视网膜是否存在黄斑水肿、黄斑萎缩,黄斑前膜、黄斑裂孔、黄斑劈裂、黄斑异常高反光等,将无异常患者分为A组,植入多焦点人工晶状体,有异常患者分为B组,术中植入非球面单焦点人工晶状体;比较两组患者术后的远近视力的差异性;比较iOCT检查结果与术后黄斑OCT检查结果的差异性。结果(1)A组患者术后3 d的远视力(0.19±0.12)、近视力(0.25±0.13)和术后30 d的远视力(0.18±0.11)、近视力(0.24±0.12)均优于B组3 d远视力(0.70±0.30)、近视力(0.70±0.16)和术后30 d的远视力(0.68±0.30)、近视力(0.69±0.14)(P<0.001);(2)156位患者在iOCT实时观察黄斑形态与术后黄斑OCT结果对比,iOCT检测出异常者44只眼,检出率为28.21%,术后黄斑OCT检查异常患者48只眼,检出率为30.77%。两种检查方法进行χ^(2)检验,结果没有统计学差异。结论iOCT在术中去除成熟的白内障后能实时清晰地观测黄斑形态,排除大部分视网膜疾病,一次性完成多焦点人工晶体植入术,提高多焦晶状体植入术后患者满意率,降低不可预知风险。Objective To investigate the application value of intraoperative optical coherence tomography(OCT)navigation microscope in mature cataract extraction before intraocular lens(IOL)implantation.Methods In this prospective case-control analysis,156 patients with mature cataract who underwent phacoemulsification combined with IOL implantation in our hospital from August 2019 to August 2021 were analyzed.All patients were applied with intraoperative OCT navigation microscope(Zeiss rescan700,iOCT)to observe the macular retina after phacoemulsification.According to the result of the observation,such as:macular edema,macular atrophy,macular epiretinal membrane,macular hole,foveoschisis,Hyper reflective foci,and et.al.,divided into A group and B group.A group was implanted with mutifocal intraocular lens without above-mentioned morphology,B group was implanted with aspheric unifocal intraocular lens with above-mentioned morphology.The difference of distant and near visual acuity between the two groups after the surgery were compared and the result of macular morphology between the real-time iOCT and spectral-domain OCT(SD-OCT)on the third day after sugery were analysised.Results 1.The far visual acuity(0.19±0.12),near visual acuity(0.25±0.13)at the 3^(rd) day and far visual acuity(0.18±0.11),near visual acuity(0.24±0.12)at the 30^(th) day of A group were better than those of B group(0.70±0.30,0.70±0.16,0.68±0.30,0.69±0.14)after operation(P<0.001);2.The detection rate of real-time iOCT in observing the macular morphology was 28.21%.The detection rate of SD-OCT on the third day after sugery was 30.77%.Conclusions iOCT can clearly observe the macular morphology in real time after removing mature cataract and efficiently assist intraocular lens implantation.iOCT navigation microscope in cataract surgery at mature stage can improve the satisfaction rate of patients after multifocal lens implantation and reduce unpredictable risks.

关 键 词：成熟期白内障 相干光层析成像术 术中导航显微镜 多焦点人工晶状体 单焦点人工晶状体 

分 类 号：R779.66[医药卫生—眼科]