飞秒激光辅助超声乳化术后不同人工晶状体有效位置和轴向位移量变化的临床研究

doi:10.3877/cma.j.issn.2095-2007.2021.02.003

目的

利用IOLMaster700对比分析飞秒激光辅助超声乳化术后3种多焦点人工晶状体术后有效位置和轴向移动量的变化趋势。

方法

选取2018年3月至12月就诊于潍坊眼科医院的年龄相关性白内障患者79例(92只眼)进行研究。所有患者均接受同一术者飞秒激光辅助超声乳化术，依据植入多焦点人工晶状体的类型将患者分为Lisa组、Restor组及Oculentis组3组，并分别植入AT Lisa tri839MP、AcrySof Restor及Oculentis LS-313型人工晶状体。使用IOLmaster700测量患者术后1周、1个月及3个月人工晶状体的有效位置(ELP)，计算每个时间段ELP的移动量。ELP的移动量以各时间段ELP变化的均方根表示。术前三组性别的描述采用例数和百分比，组间比较采用卡方检验。术前三组患者的年龄、前房深度、晶状体厚度及人工晶状体度数符合正态分布，以±s描述，组间比较采用单因方差分析。三组不同时间点ELP的比较，采用两因素重复测量方差分析。当差异具有统计学意义时，进一步采用SNK法两两比较。

结果

三组患者性别的比较，差异无统计学意义(χ²＝0.96，P>0.05)；三组患者年龄、前房深度、晶状体厚度及人工晶状体屈光度的比较，差异无统计学意义(F＝1.38，0.16，2.40，0.35，0.89；P>0.05)。Lisa组患者术后1周、1个月及3个月的ELP均值分别为(4.84±0.14)mm、(4.95±0.17)mm及(4.97±0.17)mm。三者比较的差异具有统计学意义(F＝2.29，P<0.05)；术后1个月与术后3个月的比较，差异无统计学意义(F＝0.38，P>0.05)。Restor组患者术后1周、1个月及3个月的ELP均值分别为(4.94±0.25)mm、(4.95±0.28)mm及(4.92±0.27)mm。术后1周和术后3个月与术后1个月ELP均值的比较，差异均无统计学意义(F＝0.13，0.37；P>0.05)。Oculentis组患者术后1周、1个月及3个月的ELP均值分别为(4.72±0.25)mm、(4.80±0.23)mm及(4.80±0.22)mm。术后1周与术后1个月ELP均值的比较，差异有统计学意义(F＝2.35，P<0.05)；术后1个月与术后3个月的比较，差异无统计学意义(F＝0.08，P>0.05)。三组患者术后1周、1个月及3个月ELP均值组间的比较，差异均无统计学意义(F＝1.56，1.78，1.45；P>0.05)。Lisa组、Restor组及Oculentis组ELP变化的均方根分别为(0.08±0.07)mm、(0.04±0.04)mm及(0.06±0.06)mm，三组比较的差异无统计学意义(F＝2.16，P>0.05)。

结论

3种不同设计的人工晶状体在囊袋内达到稳定状态所需的时间不同。其中，AcrySof Restor在术后1周稳定，AT Lisa tri 839MP和Oculentis LS-313在术后1个月稳定。ELP变化的均方根能够体现人工晶状体轴向的微小移动量，扫频源断层相干光成像技术是评估人工晶状体植入术后有效位置和位移量变化的有效方法。

关键词: 飞秒激光, 有效人工晶状体位置, 人工晶状体, IOLMaster700, 轴向移动量

Objective

The aim of this study was to compare and analyze the change trend and axial movement of effective lens position (ELP) in cataract patients after implantation of 3 multifocal intraocular lens by using Swept-sourceoptial coherence tomography (SS-OCT).

Methods

79 Age-related cataract patients (92 eyes) admitted to WeiFang Eye Hospital from March to December 2018 were divided into three groups: Lisa group, Restor group and Oculentis group, which were implanted by AT Lisa tri839MP, AcrySof Restor and Oculentis LS-313 intraocular lens, respectively. All patients received femtosecond laser-assisted cataract surgery by the same operator. The ELP measurements by IOLMaster700 were taken after operation for 1 week, 1 and 3 months. The ELP_RMS was defined as the root mean square (RMS) of the change in ELP at different follow-up timepoint. The number of cases and percentage were used to describe the gender of three groups before operation, and Chi-square test was used for comparison between groups. The age, anterior chamber depth, the lens thickness and the degrees of intraocular among three groups were represented by Mean±SD; single factor analysis of variance was used for comparison between groups. 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

There was non-significant different in gender among of three groups (χ²=0.96, P>0.05). There was non-significant different in age, anterior chamber depth, lens thickness and intraocular lens diopter among of three groups (F=1.38, 0.16, 2.40, 0.35, 0.89; P>0.05). The mean ELP in Lisa group after operation for 1 week, 1 month and 3 month was (4.84±0.14) mm, ( 4.95±0.17) mm and (4.97±0.17) mm, respectively. There was statistically significant different among of them (F=2.29, P<0.05). However, there was no significant changes in the mean ELP between 1 month and 3 months postoperatively (F=0.38, 0.37; P>0.05). The mean ELP in Restor group after operation for 1 week, 1 month and 3 month was (4.94±0.25) mm, (4.95±0.28) mm and (4.92±0.27) mm. The Restor group showed no significant changes in the mean ELP between 1 week and 1 month postoperatively (F=0.13, P>0.05), 1 month and 3 months postoperatively (F=0.37, P>0.05). The mean ELP in Oculentis group after operation for 1 week, 1 month and 3 months was (4.72±0.25) mm, (4.80±0.23) mm and (4.80±0.22) mm. There was significant different in the mean ELP between 1 week and 1 month postoperatively (F=2.35, P<0.05); non-significant different between 1 month and 3 months postoperatively (F=0.08, P>0.05). The difference in the mean ELP among three groups at different periods (F=1.56, 1.78, 1.45; P>0.05), which could not be considered statistically significant. The ELP_RMS of Lisa group, Restor group and Oculentis group was (0.08±0.07) mm, (0.04±0.04) mm and (0.06±0.06) mm, respectively, showing non-statistical significant difference among three groups (F=2.16, P>0.05).

Conclusions

The time required for three different designs of intraocular lens to reach stable state in the capsule bag was different. For example, AcrySof Restor required for a week, AT Lisa tri 839MP and Oculentis LS-313 for a month. The root mean of ELP changes could reflect the amount of axial movement of the intraocular lens. Swept-source optical coherence tomography is an effective method to evaluate the effective position and axial movement after intraocular lens implantation.

Key words: Femtosecond laser-assisted, Effective lens position, Intraocular lens, IOLMaster700, Axial movement

图2 Lisa组、Restor组及Oculentis组患者在术后各随访时间点人工晶状体有效位置变化的折线图

表1 三组患者术前基本情况的比较

组别	眼数(只)	男性/女性	年龄(岁)	前房深度(mm)	晶状体厚度(mm)	眼轴长度(mm)	人工晶状体屈光度(D)
Lisa组	26	14/12	61.3±10.0	3.30±0.62	4.39±0.54	24.16±1.08	19.27±2.31
Restor组	28	12/16	65.6± 9.6	3.22±0.45	4.35±0.52	23.84±1.02	20.23±2.52
Oculentis组	38	17/21	61.3±11.2	3.27±0.38	4.11±0.52	23.99±1.49	19.14±3.89
χ²/F值		0.96^*	1.38	0.16	2.40	0.35	0.89
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表1 三组患者术前基本情况的比较

组别	眼数(只)	男性/女性	年龄(岁)	前房深度(mm)	晶状体厚度(mm)	眼轴长度(mm)	人工晶状体屈光度(D)
Lisa组	26	14/12	61.3±10.0	3.30±0.62	4.39±0.54	24.16±1.08	19.27±2.31
Restor组	28	12/16	65.6± 9.6	3.22±0.45	4.35±0.52	23.84±1.02	20.23±2.52
Oculentis组	38	17/21	61.3±11.2	3.27±0.38	4.11±0.52	23.99±1.49	19.14±3.89
χ²/F值		0.96^*	1.38	0.16	2.40	0.35	0.89
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 术后各随访时间点三组ELP均值的比较(±s，mm)

组别	眼数(只)	术后1周	术后1个月	术后3个月
Lisa组	26	4.84±0.14	4.95±0.17^*	4.97±0.17
Restor组	28	4.94±0.25	4.95±0.28	4.92±0.27
Oculentis组	38	4.72±0.25	4.80±0.23^*	4.80±0.22
F值		1.56	1.78	1.45
P值		>0.05	>0.05	>0.05

表2 术后各随访时间点三组ELP均值的比较(±s，mm)

组别	眼数(只)	术后1周	术后1个月	术后3个月
Lisa组	26	4.84±0.14	4.95±0.17^*	4.97±0.17
Restor组	28	4.94±0.25	4.95±0.28	4.92±0.27
Oculentis组	38	4.72±0.25	4.80±0.23^*	4.80±0.22
F值		1.56	1.78	1.45
P值		>0.05	>0.05	>0.05

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Comparison of the change and axial movement of effective lens position of different type intraocular lens after femtosecond laser-assisted cataract surgery

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Comparison of the change and axial movement of effective lens position of different type intraocular lens after femtosecond laser-assisted cataract surgery