人工晶状体囊袋内植入时形态改变及其影响因素  

Status changes and influencing factors of intraocular lens implantation into capsule

作　　者：谢雪 梁娇娇 曲来强 严宏 Xie Xue;Liang Jiaojiao;Qu Laiqiang;Yan Hong(Shaanxi Eye Hospital,Xi'an People's Hospital(Xi'an Fourth Hospital),Affiliated People's Hospital of Northwest University,Xi'an 710004,China)

机构地区：[1]西安市人民医院(西安市第四医院)、陕西省眼科医院、西北大学附属人民医院,西安710004

出　　处：《中华实验眼科杂志》2023年第6期561-567,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：陕西省重点研发计划项目(2021ZDLSF-08);西安英才计划项目(XAYC200021)。

摘　　要：目的观察白内障术中不同设计、材质及屈光度的折叠式丙烯酸酯人工晶状体(IOL)植入晶状体囊袋时的展开形态,探讨不同因素对IOL植入过程的影响。方法采用系列病例观察方法,收集2021年2—8月于陕西省眼科医院日间手术中心完成的超声乳化白内障吸除联合IOL植入术的患者1005例。术中实时录像并记录IOL前襻、光学部、后襻在囊袋内展开的形态和时间及手术医师。植入的1005枚IOL中疏水性681枚,亲水性324枚;C襻型733枚,板式272枚;一片式909枚,三片式96枚;预装式620枚,非预装式385枚。比较非常规植入各因素差异及IOL展开时间;采用多因素Logistic回归分析影响IOL植入形态的相关因素。结果前襻植入出现非常规形态14枚(占1.4%),包括反曲7枚、折叠4枚、扭转2枚、伸直1枚;后襻非常规形态101枚(占10.0%),包括推注器内卡顿49枚、折叠40枚、反曲10枚、断裂2枚;前、后襻抱臂需辅助分开22枚(占2.2%);光学部翻转4枚(占0.4%),光学部破损2枚(占0.2%)。使用C襻型IOL发生前襻非常规植入形态的比率高于板式IOL,差异有统计学意义(P<0.05);使用亲水性、非预装、三片式、C襻型IOL发生后襻非常规植入形态的比率分别高于疏水性、预装式、一片式和板式IOL,差异均有统计学意义(χ^(2)=9.100、61.400、81.885、7.587,均P<0.05)。发生前、后襻抱臂粘连22枚(占2.2%),均为疏水性IOL;发生光学部翻转4枚(占0.4%),均为非预装式IOL。多因素Logistic回归分析显示,IOL材质、装载方式、设计及手术医师均为后襻出现非常规植入形态的影响因素(OR=9.894、3.720、6.810、1.338,均P<0.05)。疏水性IOL平均展开时间为26.12(21.21,30.91)s,明显长于亲水性IOL的3.03(2.16,4.49)s,差异有统计学意义(Z=-25.603,P<0.05);C襻型IOL平均展开时间为25.53(19.41,30.25)s,明显长于板式IOL的2.70(2.08,3.69)s,差异有统计学意义(Z=-23.764,P<0.05)。结论IOL在晶状体囊袋内植入过程�Objective To observe the unfolding status of foldable acrylic intraocular lens(IOL)of different materials,designs and refractive powers implanted in the capsular bag during cataract surgery,and to investigate its influence on the IOL implantation procedure.Methods An observational case series study was conducted.A total of 1005 patients who underwent routine phacoemulsification and IOL implantation in Shaanxi Eye Hospital from February to August 2021 were enrolled.The status and unfolding time of the leading haptic,optical region,and trailing haptic of the IOL in the capsular bag and the surgeon were recorded in real-time intraoperative video.Of the 1005 IOL implants,681 were hydrophobic,324 hydrophilic,733 C-loop,272 plate-haptic,909 single-piece,96 three-piece,620 preloaded,and 385 non-preloaded.The differences in unconventional implantation factors and IOL unfolding time were compared.The factors influencing IOL implantation status were analyzed by multivariate logistic regression.Multivariate logistic regression was used to analyze the relevant factors affecting IOL implantation status.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xi'an People's Hospital(Xi'an Fourth Hospital)(No.20200035).Written informed consent was obtained from each subject.Results There were 14(1.4%)IOLs with unconventional leading haptic status during implantation,including 7 recurved,4 folded,2 twisted and 1 straightened.There were 101(10.0%)IOLs with unconventional trailing haptic status during implantation,including 49 stuck in the injector,40 folded,10 recurved and 2 broken.There were 22(2.2%)IOLs with overlapped leading and trailing haptic requiring additional separation.There were 4(0.4%)IOLs with reversed optical regions and 2(0.2%)with damaged optical regions.The occurrence rate of unconventional leading haptic status using C-loop IOL was higher than that using plate IOL,and the difference was statistically significant(P<0.05).The occurrence rate of unconventional tr

关 键 词：白内障 人工晶状体 人工晶状体植入术 预装系统 IOL设计 IOL植入形态 

分 类 号：R779.6[医药卫生—眼科]