本文關(guān)鍵詞： 前房型人工晶狀體 角膜內(nèi)皮失代償 繼發(fā)性青光眼 人工晶狀體脫位 瞳孔橢圓化 并發(fā)性白內(nèi)障　出處：《浙江大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的：數(shù)十年來,前房型人工晶狀體在臨床上的廣泛引用使其術(shù)后并發(fā)癥愈發(fā)引起眼科醫(yī)生重視,本研究旨在對有無晶體眼兩類前房型人工晶狀體取出術(shù)原因進行分析,以期為臨床醫(yī)生提供指導(dǎo)。 方法：對浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院眼科中心2008.01至2015.02期間收治入院的40例前房型人工晶狀體取出術(shù)患者的臨床資料進行回顧性分析,從有晶體眼前房型人工晶狀體以及無晶體眼前房型人工晶狀體兩個角度對其取出術(shù)原因進行分析；并利用Wilcoxon秩和檢驗對取出前術(shù)后眼壓進行對比,同時對患者術(shù)前視力與角膜內(nèi)皮細(xì)胞密度、細(xì)胞面積標(biāo)準(zhǔn)差以及六邊形細(xì)胞比例等相關(guān)參數(shù)進行相關(guān)性分析。 結(jié)果：在40例病例(包括有晶體眼前人工晶狀體15例及無晶體眼前房型人工晶狀體25例)中,前房型人工晶狀體取出術(shù)原因：角膜內(nèi)皮失代償占47.5%,繼發(fā)性青光眼占7.5%,人工晶狀體脫位12.5%,并發(fā)性白內(nèi)障7.5%,繼發(fā)性青光眼合并角膜內(nèi)皮失代償12.5%,其他12.5%。有晶體眼前房型人工晶狀體取出術(shù)原因中前3位分別為角膜內(nèi)皮失代償(73.3%),并發(fā)性白內(nèi)障(20%),角膜內(nèi)皮失代償合并繼發(fā)性青光眼(6.7%)。而角膜內(nèi)皮失代償(32%)、人工晶狀體脫位(20%)、繼發(fā)性青光眼合并角膜內(nèi)皮失代償(16%)則為無晶體眼前房型人工晶狀體取出術(shù)原因前3位。無論有無晶體眼,角膜內(nèi)皮失代償均為主要取出術(shù)原因,且主體發(fā)生于植入術(shù)后10年及以上。有晶體眼前房型人工晶狀體取出術(shù)病例中,瞳孔橢圓化并發(fā)率為46.7%。前房型人工晶狀體取出術(shù)前眼內(nèi)壓均值為23.8±14.5mmHg,顯著高于取出術(shù)后眼內(nèi)壓16.8±9.8mmHg(p0.05).有晶體眼前房型人工晶體取出術(shù)前角膜內(nèi)皮細(xì)胞細(xì)胞面積標(biāo)準(zhǔn)差與術(shù)前最佳矯正視力具有顯著相關(guān)性(p0.05). 結(jié)論：角膜內(nèi)皮失代償是前房型人工晶狀體取出術(shù)的主要原因；前房型人工晶狀體取出術(shù)后眼內(nèi)壓較術(shù)前發(fā)生顯著降低；術(shù)前最佳矯正視力的惡化程度與角膜內(nèi)皮細(xì)胞的形態(tài)學(xué)異常呈顯著相關(guān)性,這對取出術(shù)后角膜內(nèi)皮細(xì)胞的預(yù)后具有提示作用。
[Abstract]:Objective : In the past few decades , the extensive reference of anterior chamber intraocular lens ( IOL ) in clinical practice has resulted in more and more attention paid by ophthalmologists . The aim of this study is to analyze the reasons for the removal of anterior chamber intraocular lens ( IOL ) with the presence or absence of crystalline eye , with a view to providing guidance to clinicians . Methods : The clinical data of 40 patients with anterior chamber intraocular lens ( IOL ) who were admitted to the hospital from January 2008 to 2015 were analyzed retrospectively , and the reasons of removal were analyzed from two angles of anterior chamber intraocular lens and no - crystal anterior chamber intraocular lens . The correlation of preoperative visual acuity and corneal endothelial cell density , cell area standard deviation and hexagonal cell ratio were analyzed . Results : In 40 cases ( including 15 cases with lens anterior lens and 25 cases without lens anterior chamber intraocular lens ) , anterior chamber intraocular lens was removed for the reason : corneal endothelium decompensated , secondary glaucoma 7.5 % , intraocular lens dislocation 12.5 % , cataract 7.5 % , secondary glaucoma combined with corneal endothelium decompensated 12.5 % , and other 12.5 % . Conclusion : The corneal endothelium decompensated is the main reason of anterior chamber intraocular lens removal . The anterior chamber intraocular pressure ( IOL ) is significantly lower than that before operation . The degree of deterioration of the best corrected visual acuity before operation is significantly correlated with the morphological abnormality of the corneal endothelium , which is indicative of the prognosis of corneal endothelium after removal .

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R779.6

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