超声乳化白内障吸除联合人工晶状体植入术后眼前节参数变化与屈光漂移的相关性分析

doi:10.3877/cma.j.issn.2095-2007.2017.04.002

目的

探讨超声乳化白内障吸除联合人工晶状体(IOL)植入术术前及术后患者的眼前节参数变化与屈光漂移的相关性。

方法

选取2016年5月至2017年1月于广西医科大学附属第一医院行超声乳化白内障吸除联合IOL植入术并完成随访的患者40例(42只眼)的临床资料。在术前、术后1 d、术后1周及术后1个月时，均使用Pentacam三维眼前节分析系统测量患者的角膜曲率(KM)、前房容积(ACV)、前房深度(ACD)及前房角角度(ACA)等参数，并记录屈光状态。全部数据均采用正态性检验。同一指标手术前后不同时间点之间的比较采用单因素重复测量方差分析。术后各时间点的屈光度与目标屈光度的比较采用单样本t检验。术后屈光度变化与ACD变化、ACV变化、ACA变化及KM变化之间的关系则采用Pearson线性相关分析。

结果

行超声乳化白内障吸除联合IOL植入术后，患者1 d的平均屈光度为(－0.43±0.50)D、术后1周为(－0.71±0.54)D及术后1个月为(－0.50±0.46)D。术后1 d时，患者的屈光度接近手术目标屈光度－0.50 D。但在术后1周时，近视眼度数增加。术后1个月时，近视眼度数再次接近目标屈光度。经单因素重复测量方差分析，术前与术后各时间点的差异均有统计学意义(F＝3.15，P<0.05)。患者术后1 d和术后1个月的屈光度均比术前提高(t＝－2.15，－2.01；P<0.05)。Pentacam三维眼前节分析系统检查显示，患者术后1 d的ACD为(3.99±0.53)mm、术后1周为(3.81±0.50)mm及术后1个月为(3.53±0.38)mm。术后各时间点的ACD均较术前加深(t＝8.53，8.02，5.12；P<0.05)，术后1个月的ACD比术后1 d显著减少(t＝4.57，P<0.05)。术后1 d时，患者的ACD达到最深，此后呈减小趋势。患者术后1 d时的ACV为(152.05±26.75)mm³、术后1周为(139.71±26.65)mm³及术后1个月为(127.83±25.37)mm³。患者术后的ACV均较术前增大(t＝－5.65，－3.91，－2.28；P<0.05)。与术后1 d相比，患者术后1周、术后1个月的ACV减少(t＝2.12，4.26；P<0.05)。在术后1 d时ACV达到最大，此后呈减小趋势。患者术前的ACA为(42.70±2.65)度，术后1 d为(45.44±6.45)度、术后1周为(43.83±5.81)度及术后1个月为(43.82±4.58)度。术后1 d时患者的ACA与术前相比增大(t＝－2.55，P<0.05)。患者术前的KM为(42.74±1.06)、术后1 d为(42.75±1.05)、术后1周为(42.73±1.00)及术后1个月为(42.73±1.01)，术前及术后各时间点的KM无明显差异(F＝1.61，P>0.05)。患者术后1周的屈光度变化为(－0.28±0.60)D、术后1个月的屈光度变化为(－0.07±0.68)D，术后屈光度变化与ACD变化呈正相关(r_1周＝0.73，r_1个月＝0.83；P<0.05)。术后1周的屈光度变化与术后1周的ACA变化呈弱相关(r_1周＝0.31，P<0.05)。而术后1个月的屈光度变化和ACA的变化无相关性(r_1个月＝0.14，P>0.05)；屈光度的变化与ACV的变化和KM变化之间均无明显相关性(r_1个月＝0.21，0.19；P>0.05)。

结论

行超声乳化白内障吸除联合IOL植入术后早期患者出现屈光漂移，手术后1 d的屈光状态接近手术目标屈光度，此后屈光度向近视漂移。术后1个月时近视漂移程度减轻。白内障术后早期的屈光漂移与ACD的变化密切相关。

关键词: 超声乳化白内障吸除联合人工晶状体植入术, 屈光漂移, 眼前节

Objective

Correlation between refractive index shift and changes of ocular anterior part parameters in cataract patients before and after surgery.

Methods

The clinical data of 40 patients (42 eyes) who underwent phacoemulsification and IOL(IOL) implantation in First Affiliated Hospital of Guangxi Medical University from May 2016 to January 2017 were selected and followed up. Before and after operation, one day, one week after surgery and one month after the operation, both the application of Pentacam anterior segment analysis system with the measurement of corneal curvature (KM), anterior chamber volume (ACV), anterior chamber depth (ACD) and anterior chamber angle (ACA) and other parameters, and record the refractive status.All data were tested by normality. Single factor repeated measures analysis of variance was used to compare the same index at different time points before and after operation. A single sample t-test was used to compare the postoperative diopter with the target diopter. Pearson linear correlation analysis was used to analyze the relationship between postoperative refractive changes and ACD changes, ACV changes, ACA changes and KM changes.

Results

By optometry, it was showed that the average refraction was (-0.43±0.50)D at 1one day after surgery, (-0.71±0.54)D at one week after surgery, (-0.50±0.46)D at one month after surgery. The diopter at one d after surgery was closed to the target diopter -0.50 D, while there were statistically significant increases of the degree of the myopia at one week after surgery. When one month after surgery, the diopter was closed to the target diopter again, where there was no statistically significant difference with the diopter one d after surgery(P>0.05). Pentacam system showed that the average ACD was (3.99±0.53)mm at one day after surgery, (3.81±0.50)mm at one week after surgery, (3.53±0.38)mm at one month after surgery; the average ACV was (152.05±26.75)mm³ at one day after surgery, (139.71±26.65)mm³ at one week after surgery, (127.83±25.37)mm³ at one month after surgery; the average ACA was (45.44±6.45)degree at one day after surgery, (43.83±5.81)degree at one week after surgery, (43.82±4.58)degree at one month after surgery. There was statistically significant decrease between one week, one month and the first day after surgery in the ACD and ACV (P<0.05), but there wasn′t statistically significant difference between one week, one month and the first day after surgery in the ACA (P>0.05). The average KM was (42.74±1.06) before surgery, (42.75±1.05) at one day after surgery, (42.73±1.00) at one week after surgery, (42.73±1.01) at one month after surgery, there wasn′t statistically significant difference in patients before and after surgery(P>0.05). Compared with the one day after surgery, the changes of diopter of one week, one month after surgery were (-0.28±0.60)D and (-0.07±0.68)D. The positive correlation was found between the changes of diopter and changes of ACD (r_{one week}=0.73, r_{one month}=0.83; P<0.05), also between the changes of diopter and changes of ACA at one week after surgery (r_{one week}=0.31, P<0.05), but not found at one month(r_{one month}=0.14, P>0.05). There was no statistically significant correlation between the changes of diopter and the changes of ACV, neither the changes of KM(r_{one month}=0.21, 0.19; P>0.05).

Conclusion

The phenomenon of early refractive shift may exist in the cataract patients whose diopter of one day after surgery was closed to the target diopter, then became myopic shift, finally decrease at one month after surgery. The early refractive shift is closely related with the changes of ACD.

Key words: Phacoemulsification and IOL implantation, Refractive shift, Anterior segment changes

表1 白内障患者术前与术后的屈光度及眼前节参数的比较

时间	屈光度(D)	ACD(mm)	ACV(mm³)	ACA(度)	KM
术前	－1.07±1.91	3.04±0.49	111.93±37.48	42.70±2.65	42.74±1.06
术后1 d	－0.43±0.50^*	3.99±0.53^*	152.05±26.75^*	45.44±6.45^*	42.75±1.05
术后1周	－0.71±0.54	3.81±0.50^*	139.71±26.65^*#	43.83±5.81	42.73±1.00
术后1月	－0.50±0.46^*	3.53±0.38^*#	127.83±25.37^*#	43.82±4.58	42.73±1.01
F值	3.15	31.47	14.16	2.56	1.61
P值	<0.05	<0.05	<0.05	<0.05	>0.05

表1 白内障患者术前与术后的屈光度及眼前节参数的比较

时间	屈光度(D)	ACD(mm)	ACV(mm³)	ACA(度)	KM
术前	－1.07±1.91	3.04±0.49	111.93±37.48	42.70±2.65	42.74±1.06
术后1 d	－0.43±0.50^*	3.99±0.53^*	152.05±26.75^*	45.44±6.45^*	42.75±1.05
术后1周	－0.71±0.54	3.81±0.50^*	139.71±26.65^*#	43.83±5.81	42.73±1.00
术后1月	－0.50±0.46^*	3.53±0.38^*#	127.83±25.37^*#	43.82±4.58	42.73±1.01
F值	3.15	31.47	14.16	2.56	1.61
P值	<0.05	<0.05	<0.05	<0.05	>0.05

图1 白内障患者术后1周屈光度变化和ACD变化的相关性散点图　两者的变化呈正相关

图2 白内障患者术后1个月屈光度变化和ACD变化的相关性散点图　两者的变化呈正相关

图3 白内障患者术后1周屈光度变化和ACA变化的相关性散点图　两者的变化具有较弱的正相关性

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[7]	兰小川, 黄耀忠. 翼状胬肉切除联合自体结膜移植术后角膜像差及眼前节参数变化的临床研究[J]. 中华眼科医学杂志(电子版), 2018, 08(05): 223-228.

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Correlation analysis between the changes of anterior segment parameters and refractive shift after phacoemulsification and intraocular lens implantation

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Correlation analysis between the changes of anterior segment parameters and refractive shift after phacoemulsification and intraocular lens implantation