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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2018, Vol. 08 ›› Issue (02) : 56 -63. doi: 10.3877/cma.j.issn.2095-2007.2018.02.002

所属专题： 文献；

论著

飞秒激光辅助晶状体前囊膜切开与手动撕囊的微观形态结构对比分析
陈茂盛1, 曹丹敏2, 王勇2,†(), 鲍先议3, 雷荣3, 许丽3, 黎晗3, 蒋丽娟3, 谭倩3   
  1. 1. 400020　重庆，重庆爱尔眼科医院白内障专科
    2. 410015　长沙，中南大学爱尔眼科学院；430063　武汉，武汉爱尔眼科医院白内障专科
    3. 430063　武汉，武汉爱尔眼科医院白内障专科
  • 收稿日期:2018-04-02 出版日期:2018-04-28
  • 通信作者: 王勇
  • 基金资助:
    湖北省卫计委临床医学科研项目(WJ2017M205); 爱尔眼科医院集团科研基金资助项目(AM142D17，AF152D08); 武汉市卫计委临床医学科研项目(WX15D03)

Comparative analysis of micromorphological structure of lens anterior capsulotomy and manual capsulorhexis assisted by femtosecond laser

Maosheng Chen1, Danmin Cao2, Yong Wang2,†(), Xianyi Bao3, Rong Lei3, Li Xu3, Han Li3, Lijuan Jiang3, Qian Tan3   

  1. 1. Cataract Special Department, Chongqing Aier Ophthalmology Hospital, Chongqing 400020, China
    2. School of Ophthalmology, Central South University, Changsha 410015, China; Cataract Special Department, Wuhan Aier Ophthalmology Hospital, Wuhan 430063, China
    3. Cataract Special Department, Wuhan Aier Ophthalmology Hospital, Wuhan 430063, China
  • Received:2018-04-02 Published:2018-04-28
  • Corresponding author: Yong Wang
  • About author:
    Corresponding author: Wang Yong, Email:
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引用本文：

陈茂盛, 曹丹敏, 王勇, 鲍先议, 雷荣, 许丽, 黎晗, 蒋丽娟, 谭倩. 飞秒激光辅助晶状体前囊膜切开与手动撕囊的微观形态结构对比分析[J]. 中华眼科医学杂志(电子版), 2018, 08(02): 56-63.

Maosheng Chen, Danmin Cao, Yong Wang, Xianyi Bao, Rong Lei, Li Xu, Han Li, Lijuan Jiang, Qian Tan. Comparative analysis of micromorphological structure of lens anterior capsulotomy and manual capsulorhexis assisted by femtosecond laser[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2018, 08(02): 56-63.

目的

比较飞秒激光辅助前囊膜切开与手动撕囊的形态学及超微结构的差异。

方法

采用前瞻性病例对照设计，观察重庆爱尔眼科医院2015年1月至10月接受手术治疗的白内障患者25例(40只眼)的临床资料。其中，将飞秒激光辅助前囊膜切开的患者12例(20只眼)作为试验组，手动撕囊的患者13例(20只眼)作为对照组。两组患者均在术中撕囊后取出晶状体前囊膜制成电镜标本，观察囊膜边缘的连续性、光滑度及厚薄程度。基线指标和前囊口形态学参数采用均数±标准差(±s)描述，二者的比较采用t检验。囊膜光滑度采用Kruskal－Wallis H秩和检验进行组间比较。采用裂隙灯数码照相法采集术后1周，1个月和3个月的眼前节图像，并比较前囊口形态学参数。运用两因素重复测量方差分析，进行前囊口形态学参数组间和组内不同时间点的比较。前囊口水平直径及垂直径与人工晶状体(IOL)光学部覆盖度的相关性采用Person相关分析。

结果

两组患者游离前囊膜边缘光滑度和厚度存在统计学差异，在低倍镜下观察，试验组的囊膜光滑度优于对照组，但在高倍镜下结果相反，差异均有统计学意义(Z＝－3.79，－4.54；P<0.05)；试验组的囊膜厚度小于对照组，差异有统计学意义(t＝16.62，P<0.05)。试验组和对照组患者囊膜口参数的组间和组内比较结果显示，两组间垂直直径的差异无统计学意义(F＝0.85，P>0.05)；然而，两组患者的水平直径、圆度、最小距离(囊膜缘包裹人工晶状体光学部的最小距离)、最大距离(囊膜缘包裹人工晶状体光学部的最大距离)及覆盖度差异均具有统计学意义(F＝4.45，5.51，6.76，8.92，7.99；P<0.05)；其中，除试验组最大距离小于对照组外，其他参数均为试验组大于对照组。组内比较(1周、1个月、3个月)显示，水平直径、圆度及覆盖度的差异无统计学意义(F＝0.92，0.67，0.85；P>0.05)；然而，垂直直径、最小距离及最大距离的差异具有统计学意义(F＝4.58，5.21，5.97；P<0.05)。其中，最大距离和最小距离逐渐变大，而垂直直径逐渐变小。尚未发现两组不同试点前囊口直径和覆盖度存在相关性。

结论

飞秒激光辅助前囊膜切开的连续性显著优于手动撕囊；在高倍镜下，手动撕囊游离前囊膜的边缘光滑度高于飞秒激光，在低倍镜下，飞秒激光辅助前囊膜切开的光滑度高于手动撕囊；术后3个月，飞秒激光辅助前囊膜切开的囊膜口圆度和覆盖度更优越；飞秒激光更加精准、位置居中，术后更能有效包裹IOL光学部。

关键词: 飞秒激光, 白内障, 前囊膜, 电镜扫描, 微观结构
Objective

To investigate the morphology and ultrastructural and analyze the capculorhexis morphological parameter of femtosecond laser assisted anterior capsulotomy.

Methods

A prospective case-control design was used to observe the clinical data of 25 cases (40 eyes) of cataract patients who received surgical treatment from January 2015 to October in Chongqing all ophthalmology hospital. Among them, 12 cases (20 eyes) of femtosecond laser assisted capsulorhexis wereused as experimental group, and 13 cases (20 eyes) with manual capsulorhexis as control group. The two groups of patients were removed intraocular capsulorhexis after removal of lens anterior capsule to make electron microscope specimens. The continuity, smoothness and thickness of the capsule edge were observed. The baseline parameters and morphological parameters of the anterior capsule were described by mean±standard deviation (±s), and the two were compared by t-test. The Kruskal-Wallis H rank sum test was used to compare the capsule smoothness. Using digital slit lamp to gather anterior segment pictures at 1 week, 1 month and 3 months postoperatively, analysis images to calculate capsulorhexis morphological parameters.

Results

The smooth degree and thickness of the free anterior capsule edge of the two groups were statistically different, and the low magnification capsule smoothness test group was better than the control group, but the difference was statistically significant (Z=-3.79, -4.54; P<0.05), and the membrane thickness test group was less than the control group (t=16.62, P <0.5). The comparison of the capsule oral parameters between the experimental and control groups showed that the differences in the vertical diameter between the two groups were not found to be statistically significant (F=0.85, P>0.05); however, the level diameter, roundness and minimum distance of the two groups were the minimum distance, the maximum distance and coverage of the optical part of the intraocular lens in the capsule margin (F=4.45, 5.51, 6.76, 8.92, 7.99; P<0.05). Among them, the test group was larger than the control group except the maximum distance test group. The intra group comparison (1 week, 1 months, 3 months) showed that there was no significant difference in the horizontal diameter, roundness and coverage (F=0.92, 0.67, 0.85; P>0.05), but the differences in vertical diameter, minimum distance and maximum distance were statistically significant (F=4.58, 5.21, 5.97; P<0.05). Among them, the maximum distance and minimum distance increase gradually, while the vertical diameter gradually decreases. There was no correlation between the diameter and coverage of the two groups of anterior capsular orifice.

Conclusions

This study showed that the degree of roundness and the continuity of the anterior capsule in morphological the laser group were significantly better than that of the manual group. The parameter of the anterior capsule showed that laser-created capsulotomies was more regular and more continuous than that of manually created. Laser-created capsuloto-mies covered the IOL more effective in 3 months after surgery.

Key words: Femtosecond laser, Cataract, Anterior capsule, Scanning electron microscope, Microstructure
表1 试验组和对照组患者人口学特征的比较情况(±s)
组别 例数 年龄(岁) 性别(男：女) 综合验光球镜度数(D) 眼轴长度(mm)
对照组 13 66.45±10.13 7：13 －1.73±1.93 24.44±0.73
试验组 12 64.85±13.16 6：14 －1.35±2.05 24.59±0.60
统计量 ? t＝－0.43 χ2＝0.11 t＝0.61 t＝－0.72
P值 ? >0.05 >0.05 >0.05 >0.05
图1 低倍显微镜下的飞秒激光辅助前囊膜切开形态学图像　囊膜完整，形状为圆形，连续性好
图2 低倍显微镜下的手术撕囊形态学图像　囊膜标本难以展平，囊膜边缘多处折叠、撕裂
表2 两种手术方式低倍镜下囊膜光滑度的比较
组别 眼数 非常粗糙[%(眼数/总眼数)] 粗糙[%(眼数/总眼数)] 光滑[%(眼数/总眼数)] 非常光滑[%(眼数/总眼数)]
试验组 20 10.00(2/20) 30.00(6/20) 40.00(8/20) 20.00(4/20)
对照组 20 60.00(12/20) 30.00(6/20) 10.00(2/20) 0.00(0/20)
Z值 ? －3.79
P值 ? <0.05
表3 两种手术方式高倍镜下囊膜光滑度的比较
组别 眼数 非常粗糙[%(眼数/总眼数)] 粗糙[%(眼数/总眼数)] 光滑[%(眼数/总眼数)] 非常光滑[%(眼数/总眼数)]
试验组 20 10.00(2/20) 30.00(6/20) 40.00(8/20) 20.00(4/20)
对照组 20 60.00(12/20) 30.00(6/20) 10.00(2/20) 0.00(0/20)
Z值 ? －4.54
P值 ? <0.05
图3 飞秒激光辅助前囊膜切开路径图像
图4 手工撕囊囊膜口路径图像
表4 飞秒激光撕囊与手动撕囊囊膜口的参数(±s)
组别 眼数 垂直直径(mm) 水平直径(mm) 圆度
1周 1个月 3个月 1周 1个月 3个月 1周 1个月 3个月
实验组 20 4.99±0.09 4.96±0.11 4.92±0.10 5.12±0.08 5.12±0.10 5.08±0.12 0.98±0.02 0.98±0.12 0.98±0.16
对照组 20 4.98±0.21 4.96±0.21 4.92±0.19 4.88±0.21 4.90±0.20 4.92±0.19 0.95±0.17 0.95±0.19 0.96±0.02
最小距离(mm) 最大距离(mm) 覆盖度
1周 1个月 3个月 1周 1个月 3个月 1周 1个月 3个月
0.34±0.05 0.36±0.04 0.36±0.07 0.59±0.03 0.61±0.02 0.63±0.02 0.58±0.08 0.58±0.06 0.58±0.12
0.22±0.04 0.24±0.04 0.25±0.04 0.92±0.20 0.95±0.20 0.98±0.20 0.26±0.10 0.27±0.10 0.28±0.10
图5 试验组和对照组患者术后1周囊膜口水平直径和人工晶状体光学部覆盖度的散点图
图6 试验组和对照组患者术后1个月囊膜口水平直径和人工晶状体光学部覆盖度的散点图
图7 试验组和对照组患者术后3个月囊膜口水平直径和人工晶状体光学部覆盖度的散点图
图8 试验组和对照组患者术后1周囊膜口垂直直径和人工晶状体光学部覆盖度的散点图
图9 试验组和对照组患者术后1个月囊膜口垂直直径和人工晶状体光学部覆盖度的散点图
图10 试验组和对照组患者术后3个月囊膜口垂直直径和人工晶状体光学部覆盖度的散点图
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