超声乳化白内障吸除联合肝素修饰人工晶状体植入术后炎症反应的临床观察

doi:10.3877/cma.j.issn.2095-2007.2020.01.006

目的

探讨超声乳化白内障吸除联合肝素修饰人工晶状体植入术后炎症反应的情况。

方法

收集2019年6月至2019年10月就诊于潍坊眼科医院晶状体病区诊断为年龄相关性白内障的患者62例(82只眼)进行研究。其中，男性27例(33只眼)，女性35例(49只眼)。年龄40~85岁，平均年龄(65.6±10.0)岁。根据术中植入的人工晶状体类型，将纳入研究的患者分为AQBH组、iSert组及LUCIA组等3组。三组患者均行超声乳化白内障吸除联合人工晶状体植入术，术中植入相应组名类型的人工晶状体。术后，分别于术后1 d、3 d、1周、1个月及3个月对患者进行随访，检测并记录前房闪辉检测结果，以均数±标准差描述。三组患者术后各时间点前房闪辉检测结果的比较采用两因素重复测量方差分析，当差异有统计学意义时，进一步采用SNK法进行两两比较。

结果

术后1 d，AQBH组、iSert组及LUCIA组患者术眼前房闪辉检测结果分别为(10.79±0.97)p/ms、(15.37±1.00)p/ms及(10.07±0.98)p/ms。经t检验，LUCIA组与iSert组、AQBH组与iSert组的差异有统计学意义(t＝-3.78，-3.29；P<0.05)，其余比较差异无统计学意义(t＝-3.29，P>0.05)。术后3 d，AQBH组、iSert组及LUCIA组患者术眼前房闪辉检测结果分别为(14.24±0.97)p/ms、(14.42±1.00)p/ms及(9.34±0.98)p/ms。经t检验，LUCIA组与AQBH及iSert组比较差异有统计学意义(t＝-3.54，-3.63；P<0.05)，其余比较差异无统计学意义(t＝-0.13，P>0.05)。术后1周，AQBH组、iSert组及LUCIA组患者术眼前房闪辉检测结果分别为(9.20±0.97)p/ms、(10.14±1.00)p/ms及(7.29±0.98)p/ms。经t检验，LUCIA组与iSert组的差异有统计学意义(t＝-2.03，P<0.05)，其余比较差异无统计学意义(t＝-1.38，-0.68；P>0.05)。术后1个月，AQBH组、iSert组及LUCIA组患者术眼前房闪辉检测结果分别为(9.19±0.97)p/ms、(13.17±1.00)p/ms及(7.70±0.98)p/ms。经t检验，LUCIA组与iSert组、AQBH组与iSert组比较差异有统计学意义(t＝-3.90，-2.86；P<0.05)，其余比较差异无统计学意义(t＝-1.07，P>0.05)。术后3个月，AQBH组、iSert组及LUCIA组患者术眼前房闪辉检测结果分别为(7.43±0.97)p/ms、(8.02±1.00)p/ms及(5.93±0.98)p/ms。三组比较，差异均无统计学意义(t＝-1.09，-1.49，-0.42；P>0.05)。

结论

术后1 d、3 d、1周及1个月时患者术眼前房闪辉的检测结果，LUCIA组均低于iSert组；术后3 d时略低于AQBH组(其余时间点差异无统计学意义)；术后3个月时三组均无明显差异。

关键词: 白内障, 肝素修饰人工晶状体, 前房闪辉

Objective

The aim of this study was to observe the inflammatory reactionafter phacoemulsification combined with implantation of heparin surface-modified intraocular lens.

Methods

From June 2019 to October 2019, 62 cases (82 eyes) of age-related cataract with phacoemulsification and intraocular lens implantation were studied in the Department of ophthalmology, Wei Fang Eye Hospital.Among of them, there were 27 males (33 eyes), 35 females (49 eyes), aged 40 to 85 years-old with an average age of ( 65.6±10.0) years-old. According to the intraocular lens type, the patients included in the study were divided into three groups: AQBH group, iSert group and LUCIA group.All patients of three groups received intraoperative implantation of correspondingintraocular lens (IOL) in the capsule bag. After one day, three days, one week, one month and three months operation, the subjects were follwed up to record anterior chamber flare, respectively. Three groups were compared by two factors repeated measurement variance analysis at different time points. When the difference was statistically significant, SNK method was further used for comparison.

Results

One day after operation, the anterior chamber flare of the AQBH group, iSertgroup, LUCIA group were (10.79±0.97) p/ms, (15.37±1.00) p/ms and (10.07±0.98) p/ms, respectively. There was significant difference between the LUCIA group andthe iSert group and between the AQBH group and the iSert group(t=-3.78, -3.29; P<0.05), There was no significant difference among other groups (t=-3.29, P>0.05). Three days after operation, the anterior chamber flare of the AQBH group, iSertgroup, LUCIAgroup were (14.24±0.97) p/ms, (10.14±1.00) p/ms and (7.29±0.98) p/ms, respectively. There was significant difference between the LUCIA group and the iSert group (t=-2.03, P<0.05) . There was no significant difference among other groups(t=-1.38, -0.68, P>0.05) . One month after operation, the anterior chamber flare of the AQBH group, iSert group and LUCIA group were (9.19±0.97) p/ms, (13.17±1.00) p/ms and (7.70±0.98) p/ms, respectively. There was significant difference between the LUCIA group and the iSert group and between the AQBH group and the iSert group(t=-3.90, -2.86; P<0.05). There was no significant difference among other groups(t=-1.07, P>0.05). Three months after operation, the anterior chamber flare of the AQBH group, iSert group and LUCIA group were (7.43±0.97) p/ms, (8.02±1.00) p/ms and (5.93±0.98) p/ms, respectively. There was no significant difference among three groups(t=-1.09, -1.49, -0.42; P>0.05).

Conclusions

Compared with the iSert group, the values of anterior chamber flare of the LUCIA group were lower. That data of the third day after the operation in LUCIA group were slightly lower than those in AQBH group. However, only the difference of the third day was shown statistically significant. There are no significant difference among three groups after operation for three months.

Key words: Cataract, Heparin surface-modified intraocular lens, Anterior chamber flare

表1 三组患者年龄及性别的比较

组别	例数	性别(男/女)	年龄(岁)
AQBH组	20	8/12	65.8±9.7
iSert组	20	7/13	69.0±9.4
LUCIA组	22	12/10	62.5±10.3
χ²/F值		1.78^*	2.29^**
P值		>0.05	>0.05

表1 三组患者年龄及性别的比较

组别	例数	性别(男/女)	年龄(岁)
AQBH组	20	8/12	65.8±9.7
iSert组	20	7/13	69.0±9.4
LUCIA组	22	12/10	62.5±10.3
χ²/F值		1.78^*	2.29^**
P值		>0.05	>0.05

图1 三组患者术后1 d、3 d、1周、1个月及3个月前房闪辉的检测结果

表2 三组患者术后1 d、3 d、1周、1个月及3个月时组间前房闪辉检测结果的比较(±s，p/ms)

组别	眼数	术后1 d	术后3 d	术后1周	术后1个月	术后3个月
AQBH组	28	10.79± 0.97	14.24± 0.97	9.20± 0.97	9.19± 0.97	7.43± 0.97
iSert组	27	15.37± 1.00^a	14.42± 1.00	10.14± 1.00	13.17± 1.00 ^a	8.02± 1.00
LUCIA组	27	10.07± 0.98^b	9.34± 0.98 ^{a b}	7.29± 0.98 ^b	7.70± 0.98 ^b	5.93± 0.98

表2 三组患者术后1 d、3 d、1周、1个月及3个月时组间前房闪辉检测结果的比较(±s，p/ms)

组别	眼数	术后1 d	术后3 d	术后1周	术后1个月	术后3个月
AQBH组	28	10.79± 0.97	14.24± 0.97	9.20± 0.97	9.19± 0.97	7.43± 0.97
iSert组	27	15.37± 1.00^a	14.42± 1.00	10.14± 1.00	13.17± 1.00 ^a	8.02± 1.00
LUCIA组	27	10.07± 0.98^b	9.34± 0.98 ^{a b}	7.29± 0.98 ^b	7.70± 0.98 ^b	5.93± 0.98

[1]	Vecchio PJD, Bizios R, Holleran LA, et al. Inhibition of human scleral fibroblast proliferation with heparin[J]. Investigative Ophthalmology & Visual Science, 1988, 29(8): 1272-1276.
[2]	Liu T, Hu AH, Hu QJ, et al. Objective assessment of the inflammatory reaction in foldable heparin surface-modified hydrophilic acrylic intraocular lens[J]. International Eye Science, 2016, 16(1): 11-13.
[3]	韩丁，吴淑英，李筱荣. 中老年人视觉损害的流行病学调查[J]. 中华眼视光学与视觉科学杂志，2013，15(1)：61-64.
[4]	Elizabeth KJ, Casson RJ, Konrad P, et al. Prevalence and causes of vision loss in South-east Asia and Oceania in 2015: magnitude, temporal trends and projections[J]. British Journal of Ophthalmology, 2019, 103(7): 878-884.
[5]	Wong TY, Tham YC, Sabanayagam C. Patterns and Risk Factor Profiles of Visual Loss in a Multi-ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study[J]. American journal of ophthalmology, 2019, 206(5): 48-73.
[6]	Flaxman SR, Bourne RRA, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990—2020: a systematic review and meta-analysis[J]. The Lancet, 2017, 5(12): e1221-e1234.
[7]	Taryam MO, Rabiu MM, Muhammad N, et al. Prevalence and causes of blindness and visual impairmentand cataract surgical services in Katsina state of Nigeria[J]. Br J Ophthalmol, 2019: 314572.
[8]	姜淑敏，韩琪. 白内障手术方式及人工晶状体的选择与进展[J]. 医学综述，2010，40(9)：114-116.
[9]	Kelman CD. Phacoand aspiration. A new technique of cataract removal: A preliminary report[J]. Am J Ophthalmol, 1967, 64 (1): 23-35.
[10]	李湘宁，李晓云. 人工晶状体的发展趋势及展望[J]. 光学仪器，2017，39(6)：77-83.
[11]	Nagy Z, Takacs A, Filkorn T, et al. Initial Clinical Evaluation of an Intraocular Femtosecond Laser in Cataract Surgery[J]. Journal of Refractive Surgery, 2009, 25(12): 1053-1060.
[12]	姚克，鱼音慧. 重视飞秒激光辅助白内障手术的新认识[J]. 中华眼科医学杂志(电子版)，2017，7(3)：97-102.
[13]	张旻，蒋永祥. 把握白内障手术的发展趋势与精准运用人工晶状体各种类型的特点[J/CD]．中华眼科医学杂志(电子版)，2019，9(5)：257-266.
[14]	袁佳琴，孙慧敏，徐延山，等. 氟-肝素表面修饰人工晶状体的实验研究[J]. 眼科新进展，2003，23(3)：153-156.
[15]	王桂琴，袁佳琴，孙慧敏，等. 氟-肝素修饰的人工晶状体表面黏附细胞的实验研究[J]. 中华眼科杂志，2002，38(3)：154-156.
[16]	Jones H, Paul W. The effects of heparin and related molecules on vascular permeability and neutrophil accumulation in rabbit skin[J]. British Journal of Pharmacology, 2002, 135(2): 469-479.
[17]	Krall EM, Arlt EM, Jell G, et al. Intraindividual aqueous flare comparison after implantation of hydrophobic intraocular lenses with or without a heparin-coated surface[J]. Journal of Cataract and Refractive Surgery, 2014, 40(8): 1363-1370.
[18]	Nishi O, Nishi K, Imanishi M, et al. Decreased prostaglandin E2 synthesis by lens epithelial cells cultured on heparin-surface-modified poly(methyl methacrylate)[J]．Journal of Cataract and Refractive Surgery, 1996, 22(Suppl 1): 859-862.
[19]	Amon M, Menapace R, Radax U. In vivo study of cell reactions on poly(methyl methacrylate) intraocular lenses with different surface properties[J]．Journal of Cataract and Refractive Surgery, 1996, 22(Suppl 1): 825-829.
[20]	Trocme SD. Effect of heparin-surface-modified intraocular lenses on postoperative inflammation after phacoemulsification: a randomizedtrial ina United States patient population Heparin-Surface-Modified Lens Study Group[J]. Ophthalmology, 2000, 107(6): 1031-1037.
[21]	Mester U, Strauss M. Biocompatibility and blood-aqueous barrier impairment in at-risk eyes with heparin-surface-modified or unmodified lenses[J]．Journal of Cataract and Refractive Surgery, 1998, 24(3): 380-384.
[22]	Wang GQ, Gu HQ, Yuan JQ, et al. F-heparin modified intraocular lenses in Rhesus monkeys[J]．International Journal of Ophthalmology, 2010, 3(2): 141-144.
[23]	刘逸. 肝素处理人工晶状体在糖尿病白内障手术中的应用[J]. 中外医疗，2011，1(3)：6-7.
[24]	Tabbara KF, Al-Kaff AS, Al-Rajhi AA, et al. Heparin surface-modified intraocular lenses in patients with inactive uveitis or diabetes[J]. Ophthalmology, 1998, 105(5): 843-845.
[25]	Jones NP. Cataract surgery using heparin surface-modified intraocular lenses in Fuchs′ heterochromic uveitis[J]. Ophthalmic Surgery, 1995, 26(1): 49-52.
[26]	Dada T, Dada VK, Sharma N. Primary posterior capsulorhexis with optic capture and intracameral heparin in paediatric cataract surgery[J]. Clinical & Experimental Ophthalmology, 2000, 28(5): 361-363.
[27]	Basti S, Aasuri MK, Reddy MK, et al. Heparin-surface-modified intraocular lenses in pediatric cataract surgery: prospective randomized study[J]. Journal of Cataract and Refractive Surgery, 1999, 25(6): 782-787.
[28]	Sawa M, Tsurimaki Y, Tsuru T. New quantitative method to determine protein concentration and cell number in aqueous in vivo[J]．Japanese Journal of Ophthalmology, 1988, 32(2): 132-142.
[29]	Larsson LI. Increased permeability of the blood-aqueous barrier after panretinal photocoagulation for proliferative diabetic retinopathy[J]. Acta ophthalmologica Scandinavica, 2001, 79(4): 414-416.
[30]	Schauersberger J, Kruger A, Müllner-Eidenböck A, et al. Long-term disorders of the blood-aqueous barrier after small-incision cataract surgery[J]. Eye (London, England), 2000, 14 (Pt1): 61-63.
[31]	Tetsumoto A, Imai H, Otsuka K, et al. Clinical factors contributing to postoperative aqueous flare intensity after 27-gauge pars plana vitrectomy for the primary rhegmatogenous retinal detachment[J]. Japanese Journal of Ophthalmology, 2019, 63(4): 317-321.
[32]	Nguyen NX, Langenbucher A, Seitz B, et al. Blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation[J]. Graefes Arch Clin Exp Ophthalmol, 2001, 239(2): 114-117.
[33]	Stock G, Ahlers C, Dunavoelgyi R, et al. Evaluation of anterior-segment inflammation and retinal thickness change following cataract surgery[J]．Acta Ophthalmologica, 2011, 89(4): 369-375.
[34]	郑连山. 人工晶状体植入后血-房水屏障机能的定量分析[J]. 中华眼科杂志，1994，30(3)：232-233.
[35]	周洋，景昕虹，李效岩. 激光蛋白细胞检测仪在葡萄膜炎中的应用价值[J]. 国际眼科杂志，2013，13(9)：41-43.
[36]	胡爱华，施玉英. 不同材料和设计的人工晶状体对白内障术后炎症反应的影响[J]. 眼科，2005，14(3)：43-46.
[37]	Shah SM. Comparison of the postoperative inflammatory response in the normal eye with heparin-surface-modified and poly(methyl methacrylate) intraocular lenses[J]. Journal of Cataract and Refractive Surgery, 1995, 21(5): 579-585.
[38]	Han Y, Tang J, Xia J, et al. Anti-Adhesive And Anti-proliferative Synergistic Surface Modification of Intraocular Lens for Reduced Posterior Capsular Opacification[J]. Int J Nanomedicine, 2019, 14: 9047-9061.
[39]	Ygge J, Wenzel M, Philipson B, et al. Cellular Reactions on Heparin Surface-modified versus Regular PMMA Lenses during the First Postoperative Month[J]. Ophthalmology, 1990, 97(9): 1216-1224.
[40]	Dada T, Data VK, Sharma N, et al. Primary posterior capsulorhexis with optic capture and intracameral heparin in paediatric cataract surgery[J]. Clinical & Experimental Ophthalmology, 2000, 28(5): 361-363.
[41]	Krall EM, Arlt EM, Jell G, et al. Prospective Randomized Intraindividual Comparison of Posterior Capsule Opacification After Implantation of an IOL With and Without Heparin Surface Modification[J]. Journal of Refractive Surgery, 2015, 31(7): 466-472.
[42]	程金伟，叶小苹，魏锐利，等. 肝素化人工晶状体预防后囊膜混浊的Meta分析[J]. 中华实验眼科杂志，2008，26(6)：462-465.
[43]	Kang S, Choi JA. Comparison of posterior capsular opacification in heparin-surface-modified hydrophilic acrylic and hydrophobic acrylic intraocular lenses[J]. Japanese Journalof Ophthalmology, 2009, 53(3): 204-208.
[44]	吴丹萍，吴强. 不同表面处理及设计人工晶状体对后囊膜混浊影响的量化分析[J]. 国际眼科杂志，2019，19(11)：1908-1911.
[45]	Maede lS, Hirnschall N, Chen YA. Effect of heparin coating of a foldable intraocular lens on inflammation and capsular bag performance after cataract surgery[J]. Journal of Cataract and Refractive Surgery, 2013, 39(12): 1810-1817.

[1]	陈川, 罗红. 胎儿先天性白内障的超声影像学特征及预后分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(05): 548-552.
[2]	孙秀丽, 刘振宇, 唐婷婷, 张景尚, 李猛, 毛迎燕, 万修华. 关注后发性白内障的发病机制及防控措施[J]. 中华眼科医学杂志(电子版), 2023, 13(04): 193-198.
[3]	陈灏楠, 肖伟. 透明角膜切口对白内障术后角膜散光的影响及其精准测量的研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(03): 172-176.
[4]	方蕊, 宋旭东. 非编码核糖核酸与白内障相关的研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(02): 94-98.
[5]	郝壮, 马济远, 何梦梅, 李兴育, 陆新婷, 武静, 周健. 迟发性囊袋阻滞综合征临床特征、治疗方法及其疗效的临床研究[J]. 中华眼科医学杂志(电子版), 2023, 13(02): 70-75.
[6]	刘兆川, 宋旭东. 重视虹膜松弛综合征围手术期的防治[J]. 中华眼科医学杂志(电子版), 2023, 13(01): 1-5.
[7]	万修华. 角膜移植术后白内障吸除联合张力环及后房型人工晶状体植入术[J]. 中华眼科医学杂志(电子版), 2022, 12(06): 0-.
[8]	万修华. 白内障标准化手术系列视频（5级全白核）[J]. 中华眼科医学杂志(电子版), 2022, 12(05): 0-.
[9]	王震宇, 张维嘉, 胡曼, 高传文, 石砚, 王怀洲. 微导管辅助360°小梁切开术治疗先天性白内障术后继发青光眼的临床研究[J]. 中华眼科医学杂志(电子版), 2022, 12(05): 275-280.
[10]	王晓宇, 李亚新, 刘一昀, 耿嘉懿, 秦锐, 李炎城, 敖明昕, 刘德海, 齐虹. 不同设计多焦点人工晶状体植入后视觉质量差异的临床研究[J]. 中华眼科医学杂志(电子版), 2022, 12(04): 210-215.
[11]	姜雅琴, 刘丽峰, 刘秀花, 张亚丽. 白内障术后早期患者配戴绷带镜对泪膜质量及其动态变化影响的临床研究[J]. 中华眼科医学杂志(电子版), 2022, 12(04): 204-209.
[12]	蒋晨, 万新娟, 谢小东, 丁琳. 糖化血红蛋白、硫氧还蛋白、硫氧还蛋白互作蛋白与皮质性白内障的关系[J]. 中华临床医师杂志(电子版), 2022, 16(09): 914-918.
[13]	付鹏, 沈念, 黄艳玲, 杨水平, 万小波. 外伤性晶状体脱位合并周边隐匿性视网膜病变的临床特征及预后分析[J]. 中华临床医师杂志(电子版), 2022, 16(06): 536-540.
[14]	彭丽, 于娜, 吴雪莲. 老年白内障患者超声乳化术后眼部疼痛原因分析[J]. 中华老年病研究电子杂志, 2023, 10(02): 49-51.
[15]	刘天龙. 改良型超声乳化手术治疗高度近视合并白内障疗效观察[J]. 中华老年病研究电子杂志, 2023, 10(01): 30-33.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical observation of inflammatory reaction after phacoemulsification combined with implantation of heparin surface-modified intraocular lens

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical observation of inflammatory reaction after phacoemulsification combined with implantation of heparin surface-modified intraocular lens