3D CT眼球重建技术用于评估高度近视白内障眼球形态和人工晶状体度数预测精确度的研究  

Application of 3D CT eyeball reconstruction technology in morphological assessment of the eyeball and intraocular lens power calculation in high myopia cataract

作　　者：买尔哈巴·玉素甫 刘晓弟 甫拉提·阿布都热衣木[1] MAIERHABA Yusufu;LIU Xiaodi;FULATI(Abudoureyimu.Department of Ophthalmology,People’s Hospital of Xinjiang Autonomous Region,Urumqi 830002,China)

机构地区：[1]新疆维吾尔自治区人民医院眼科,乌鲁木齐830002

出　　处：《中国眼耳鼻喉科杂志》2024年第3期182-190,共9页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：新疆维吾尔自治区人民医院院内项目(20210228)。

摘　　要：目的探索3D CT眼球重建技术在评估高度近视白内障眼球形态和人工晶状体(IOL)度数预测精确度的应用。方法收集2021年8—12月行白内障超声乳化吸除联合IOL植入术的高度近视患者,眼轴长度(AL)≥26.5 mm,共计52例(52眼),随访1个月。完善眼眶薄层CT(扫描层厚0.3 mm),记录眼底黄斑萎缩、牵引、新生血管病变(ATN)分级,比较术后最佳矫正视力(BCVA)和屈光度平均绝对误差(MAE),分析不同类型后巩膜葡萄肿的眼球形态之间的差异。利用SPSS 20.0对数据进行统计分析,P<0.05为差异有统计学意义。结果高度近视眼3D CT眼球形态分类如下:球形8眼(15.4%)、椭球形4眼(7.7%)、锥形13眼(25%)、鼻侧扭曲形12眼(23.1%)、颞侧扭曲形7眼(13.5%)、桶形8眼(15.4%)。在年龄<60岁患者组中,球形8眼(25.0%)、锥形8眼(25.0%),比例最高,椭球形1眼(3.1%)、颞侧扭曲形4眼(10.5%),比例最低;在年龄≥60岁患者组中,没有球形眼球,而锥形5眼(25%)和鼻侧扭曲形7眼(35%),比例最高,提示随着年龄增加,后巩膜葡萄肿出现比例增加,差异有统计学意义(P<0.001)。同时,当AL<28 mm时,球形眼球7眼(38.9%),比例最高;而当AL≥30 mm时,没有球形眼球,锥形6眼(26.1%)、颞侧扭曲形5眼(21.7%)和桶形5眼(21.7%),比例增加,提示随着AL增加,后巩膜葡萄肿发生率增加,并且容易出现黄斑区的葡萄肿,差异有统计学意义(P<0.001)。无后巩膜葡萄肿的球形眼球患者白内障术后有87.5%的患者BCVA达到20/40及以上,而伴有后巩膜葡萄肿者视力预后不佳,尤其锥形有6眼(46.2%)和颞侧扭曲有3眼(42.9%)的BCVA<20/40,差异有统计学意义(χ^(2)=46.755,P<0.001)。高度近视黄斑ATN分级提示,锥形、颞侧扭曲和桶形眼球的眼底病变更加明显,分级更高。高度近视眼中有30眼(57.7%)白内障术后MAE<0.5 D,其中椭球形、锥形和颞侧扭曲形眼球IOL度数预测准确性最差,仅有25%、53.9%和37.5%眼MAE<0.5 D;球形和鼻侧扭曲形�Objective To explore the application of 3D CT eyeball reconstruction technology in high myopia cataract intraocular lens(IOL)power calculation and vision prediction.Methods A prospective study was conducted on patients who had undergone cataract phacoemulsification combined with IOL implantation in the department of ophthalmology from August to December 2021.The follow-up period was 1 month.A total of 52 patients(52 eyes)with high myopic cataract and axial length(AL)≥26.5 mm were collected.All patients completed orbital thin CT(scanning layer thickness 0.3 mm).The atrophic,tractional and neovascular(ATN)grading of the fundus,best corrected visual acuity(BCVA)and mean absolute error(MAE)after surgery were recorded during the follow-up period,and the differences in the ocular morphology of different types of posterior scleral staphyloma were analyzed.SPSS 20.0 was used for statistical analysis of the data and there was a statistically significant difference when P<0.05.Results The classification of 3D CT eyeball morphology in 52 patients with high myopia was as follows:spherical in 8 eyes(15.4%),elliptical in 4 eyes(7.7%),conical in 13 eyes(25%),nasal distorted in 12 eyes(23.1%),temporal distorted in 7 eyes(13.5%),barrel in 8 eyes(15.4%).Among the patients with age<60 years old,the proportion of spherical 8 eyes(25.0%)and conical 8 eyes(25.0%)were the highest,the proportion of elliptical 1 eye(3.1%)and temporal distorted 4 eyes(10.5%)was the lowest.However,in the patients with age≥60 years old,there was no spherical eyeball,while the proportion of 5 eyes with conical shape(25%)and 7 eyes with nasal distorted shape(35%)was the highest,suggesting that the proportion of posterior scleral staphyloma increased with age,with a statistically significant difference(P<0.001).At the same time,when the AL was less than 28 mm,the proportion of spherical eyeballs(38.9%)was the highest.However,when the AL≥30 mm,there was no spherical eyeball,and the proportion of conical 6 eyes(26.1%),temporal distorted 5 eyes(21.7%)and ba

关 键 词：高度近视 白内障 后巩膜葡萄肿 3D CT 屈光度误差 

分 类 号：R776.1[医药卫生—眼科]