本文關(guān)鍵詞： IOL Master 軸性高度近視 PKP術(shù)后 并發(fā)性白內(nèi)障　出處：《濟(jì)南大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分IOL Master應(yīng)用于軸性高度近視并發(fā)性白內(nèi)障患者的臨床觀察 目的 對IOL Master應(yīng)用于軸性高度近視并發(fā)性白內(nèi)障患者生物測量和人工晶狀體度數(shù)預(yù)測的準(zhǔn)確性進(jìn)行研究，為臨床應(yīng)用提供參考依據(jù)。 方法 收集2006年8月至2012年3月因高度近視并發(fā)性白內(nèi)障于我院行手術(shù)治療且資料完善的患者78例112眼。男29例，女49例；年齡19-82歲，平均55.8歲，全部患者均行白內(nèi)障超聲乳化吸除聯(lián)合折疊式人工晶狀體植入手術(shù)治療。術(shù)前最佳矯正視力為HM~0.6，屈光度為-6.00~-29.00D，眼軸長度26mm。按照眼軸長度（AL）進(jìn)行分組，分為26mmAL≤28mm組43眼，28mmAL≤30mm組33眼，AL30mm組36眼。術(shù)前分別應(yīng)用接觸性A超聯(lián)合角膜曲率計和IOL Master行生物測量和人工晶狀體度數(shù)預(yù)測，術(shù)后三個月行規(guī)范主覺驗光。比較兩種測量方式的檢出率，眼軸長度、角膜曲率、前房深度以及人工晶狀體預(yù)測度數(shù)的差異和相關(guān)性，根據(jù)不同的眼軸長度計算比較術(shù)后絕對屈光誤差并分析其差異。采用SPSS17.0統(tǒng)計軟件進(jìn)行數(shù)據(jù)分析，率的比較采用卡方檢驗，配對資料的比較采用配對t檢驗，成組資料的比較采用單因素方差分析，兩種儀器間測量所得數(shù)據(jù)的相關(guān)性采用Pearson相關(guān)分析，兩種儀器測量的所得數(shù)據(jù)的一致性檢驗用Bland-Altman圖表示，以P0．05為差異有統(tǒng)計學(xué)意義。 結(jié)果 1．IOL Master對軸性高度近視并發(fā)性白內(nèi)障的檢出率為83.9%，接觸性A超聯(lián)合角膜曲率計的檢出率為100%，兩者比較差異有統(tǒng)計學(xué)意義（P=0），對于晶狀體混濁重的患者中，傳統(tǒng)方法的檢出率高于IOL Master。 2．接觸性A超測得的AL為（29.16±2.38）mm，IOL Master測得的AL為（29.35±2.49）mm，兩者比較差異存在統(tǒng)計學(xué)意義（P=0），兩者具有高度相關(guān)性（r=0.99，P=0）。隨著眼軸長度的增加，IOL Master和接觸性A超所測得的眼軸長度差逐漸增大，分別為0.04mm，0.18mm，0.28mm。 3．角膜曲率計測得的角膜曲率Km為（44.31±1.45）D，IOL Master測得的Km為（44.20±1.45）D，兩者比較差異有統(tǒng)計學(xué)意義，兩者具有高度相關(guān)性。 4．接觸性A超和IOL Master所測得的前房深度比較差異無統(tǒng)計學(xué)意義（t=-1.518，P=0.134）。 5．按照SRK/T公式，IOL Master計算的IOL度數(shù)為（3.63±6.36）D，接觸性A超聯(lián)合角膜曲率計計算的IOL度數(shù)為（3.36±6.49）D，兩者比較差異有統(tǒng)計學(xué)意義（t=7.152，P=0），兩者具有高度相關(guān)性（r=0.99，P=0）。應(yīng)用IOL Master四種公式所測得的IOL度數(shù)比較差異無統(tǒng)計學(xué)意義（F=0.027，P=0.994）。 6．IOL Master和接觸性A超聯(lián)合角膜曲率計術(shù)前預(yù)留屈光度分別為（-0.93±0.58）D，（-1.02±0.41）D，術(shù)后三個月等效球鏡為（-0.42±0.69）D，與前兩者比較差異均有統(tǒng)計學(xué)意義（t1=-3.568，P=0.001；t2=-4.829，P=0）。 7．應(yīng)用IOL Master以SRK/T公式計算，三組術(shù)后術(shù)后絕對屈光誤差分別為（0.10±0.31）D、（0.73±0.34）D、（1.19±0.77）D，三者比較差異有統(tǒng)計學(xué)意義（F=25.87，P=0），隨眼軸長度的增加，術(shù)后絕對屈光誤差增加。8應(yīng)用IOL Master的SRK/T公式預(yù)測IOL度數(shù)，將術(shù)后絕對屈光誤差與術(shù)前前房深度測量值進(jìn)行Pearson相關(guān)性分析，r=0.186，P=0.237（P0.05），兩者之間不存在明顯相關(guān)關(guān)系。 結(jié)論 IOL Master應(yīng)用于軸性高度近視患者人工晶狀體度數(shù)預(yù)測的準(zhǔn)確性高于接觸性A超聯(lián)合角膜曲率計，但對于晶狀體核Ⅳ級或嚴(yán)重的皮質(zhì)、后囊下混濁的病例，其檢出率較低，在臨床應(yīng)用中仍不能完全取代傳統(tǒng)測量方法。隨著眼軸長度的增加，IOL Master預(yù)測人工晶狀體度數(shù)的術(shù)后絕對屈光誤差增加，需要根據(jù)不同的眼軸長度選擇合適的人工晶狀體度數(shù)，以避免術(shù)后出現(xiàn)過矯。 第二部分IOL Master應(yīng)用于穿透性角膜移植術(shù)后的臨床觀察 目的 通過IOL Master和A超聯(lián)合Oculyzer對穿透性角膜移植術(shù)后患者行生物學(xué)測量及人工晶狀體度數(shù)預(yù)測，探討IOL Master應(yīng)用于PKP術(shù)后的準(zhǔn)確性。 方法 收集2012年1月到2012年4月期間穿透性角膜移植手術(shù)后于山東省眼科醫(yī)院復(fù)查的患者15例（16眼），其中男性9例，女性6例，平均年齡34歲（21-48歲），角膜植片直徑為7.5-8.5mm，裸眼視力為FC-0.6，全部患者角膜植片透明，未發(fā)現(xiàn)明顯角膜植片免疫排斥反應(yīng)或排斥反應(yīng)已治愈3個月，眼部無充血，前房無明顯炎癥反應(yīng)。所有患者均采用IOL Master500和接觸性A超聯(lián)合眼前節(jié)分析系統(tǒng)（Oculyzer）行人工晶狀體（IOL）度數(shù)測算。分別比較兩種測量方式的檢出率，以及測量眼軸長度、角膜曲率、前房深度的差異和相關(guān)性，比較人工晶狀體度數(shù)預(yù)測的準(zhǔn)確性。采用SPSS17.0統(tǒng)計軟件進(jìn)行數(shù)據(jù)分析，率的比較采用卡方檢驗，配對資料的比較采用配對t檢驗，成組資料的比較采用單因素方差分析，兩種儀器間測量所得數(shù)據(jù)的相關(guān)性采用Pearson相關(guān)分析，以P0．05為差異有統(tǒng)計學(xué)意義。 結(jié)果 1．IOL Master和接觸性A超對PKP術(shù)后眼軸長度的檢出率比較差異無統(tǒng)計學(xué)意義（X2=1.032，P=0.310）。IOL Master對PKP術(shù)后角膜曲率的檢出率為56.25%，Oculyzer角膜曲率的檢出率為100%，兩者比較差異有統(tǒng)計學(xué)意義（X2=8.96，P=0.003）。 2．IOL Master所測得的眼軸長度為（23.47±1.55）mm，接觸性A超所測得的眼軸長度為（23.31±1.53）mm，IOL Master所測眼軸長度比A超長0.16mm，兩者比較差異存在統(tǒng)計學(xué)意義（t=-4.153，P=0.002），兩者存在高度相關(guān)性（r=0.99，P=0）。 3．IOL Master所測得的Km為（41.49±3.22）D，Oculyzer所測得的Km為（43.0±2.41）D，兩者比較差異有統(tǒng)計學(xué)意義（t=4.571，P=0.006），兩者存在高度相關(guān)性。IOL Master所測得的散光度為（9.04±3.96）D，Oculyzer所測得的散光度為（6.70±1.64）D，兩者比較差異無統(tǒng)計學(xué)意義（t=-2.469，P=0.057），兩者存在高度相關(guān)性。 4．接觸性A超所測得的前房深度為（2.77±0.39）mm，IOL Master所測得的前房深度為（2.82±0.44）mm，Oculyzer所測得的前房深度為（2.90±0.50）mm，三種測量方法兩兩比較差異均有統(tǒng)計學(xué)意義（t1,2=-2.388，P=0.036；t2,3=-3.370，P=0.006；t1,3=-4.225，P=0.001）。 5．按照SRK/T公式計算IOL度數(shù)，IOL Master所測得為（28.18±7.61）D，接觸性A超聯(lián)合Oculyzer所測得的為（26.01±6.26）D，兩者比較差異存在統(tǒng)計學(xué)意義（t=-5.892，P=0）。結(jié)論 IOL Master對穿透性角膜移植術(shù)后患者行生物學(xué)測量，其角膜曲率的檢出率明顯低于Oculyzer，其眼軸長度的測量較接觸性A超準(zhǔn)確，但角膜曲率測量的準(zhǔn)確性較Oculyzer差，因此在臨床上對穿透性角膜移植術(shù)后患者行人工晶狀體度數(shù)預(yù)測時應(yīng)綜合兩種儀器的測量結(jié)果，同時考慮縫線等影響因素，，才能選擇出更加合適的人工晶狀體度數(shù)。
[Abstract]:The clinical observation of the first part of IOL Master in patients with complicated cataract with axial high myopia
objective
Objective to study the accuracy of biometric and intraocular lens degree prediction of IOL Master in patients with cataract complicated by axial high myopia, so as to provide reference for clinical application.
Method
From August 2006 to March 2012 for cataract with high myopia in our hospital for surgical treatment of patients with complete data of 78 eyes of 112 cases. 29 cases were male, 49 were female; the average age is 19-82 years old, 55.8 years old, all the patients underwent phacoemulsification and foldable intraocular lens implantation surgery. Preoperative best corrected visual acuity HM~0.6, diopter -6.00~-29.00D, axial length 26mm. in accordance with the axial length (AL) were divided into 26mmAL 28mm group 43 eyes, 28mmAL 30mm group 33 eyes, 36 eyes in group AL30mm before operation respectively. Application of contact A ultrasound combined with corneal curvature and IOL meter Master for biological measurement and intraocular lens the degree of prediction, three months after the operation of subjective refraction. The detection rate of two kinds of measurement methods, axial length, corneal curvature, anterior chamber depth and intraocular lens degree prediction difference and correlation, according to different axial length Calculation and comparison of postoperative absolute refractive errors and analysis the differences. The data were analyzed by SPSS17.0 statistical software, were compared using the chi square test, paired data were compared using paired t test was used to compare group data of single factor variance analysis, two kinds of instruments between the measured data correlation analysis using Pearson correlation, consistency two kind of test instrument for measuring the data show in Bland-Altman, with P0.05 as the difference was statistically significant.
Result
The detection rate of 1.IOL Master for axial high myopia complicated cataract is 83.9%, and the detection rate of contact A ultra combined corneal curveter is 100%, the difference between them is statistically significant (P=0). For turbidity heavy patients, the detection rate of traditional method is higher than that of IOL Master..
2. contact A measured AL (29.16 + 2.38) mm, IOL Master AL measured for (29.35 + 2.49) mm, there was significant difference between the two groups (P=0), the two are highly correlated (r=0.99, P=0). With the increase of axial length, axial length of IOL and Master contact A the measured difference increases, respectively 0.04mm, 0.18mm, 0.28mm.
3. the corneal curvature Km measured by corneal curvature meter was (44.31 + 1.45) D, and the Km measured by IOL Master was (44.20 + 1.45) D, the difference between them was statistically significant, and the correlation between them was highly correlated.
There was no significant difference in the depth of anterior chamber between 4. contact A and IOL Master (t=-1.518, P=0.134).
5. according to the SRK/T formula, IOL Master calculation of the IOL degree (3.63 + 6.36) D, A ultrasound combined with corneal curvature contact calculation IOL degree (3.36 + 6.49) D, the difference was statistically significant (t=7.152, P=0), the two are highly correlated (r=0.99, P=0) had no statistical significance. Should as measured by IOL Master four formula IOL degree difference (F=0.027, P=0.994).
6.IOL Master and contact A ultrasound combined with corneal curvature before surgery for diopter respectively (-0.93 + 0.58) D, (-1.02 + 0.41) D, three months after the operation for the spherical equivalent (-0.42 + 0.69) D, compared with the former two differences were statistically significant (t1=-3.568, P=0.001; t2=-4.829, P =0).
7. application of IOL Master calculated by SRK/T formula, three groups of postoperative absolute refractive error were (0.10 + 0.31) D, (0.73 + 0.34) D, (1.19 + 0.77) D, there was a significant difference between the three groups (F=25.87, P=0), with the increase of axial length, postoperative absolute the refractive error formula of.8 application of IOL Master SRK/T increased IOL to forecast the degree of postoperative absolute refractive error and preoperative anterior chamber depth measurements were analyzed by Pearson correlation analysis, r=0.186, P=0.237 (P0.05), there was no significant correlation between the two.
conclusion
The accuracy of IOL application of Master in high myopia patients with IOL prediction than contact A ultrasound combined with corneal keratometer, but for the lens nucleus IV or severe cortex, posterior capsule opacification cases, the detection rate is relatively low, still can not completely replace the traditional measurement methods in clinical application. With the increase of eye the axial length of the IOL Master prediction of intraocular lens after absolute refractive error increases, need to be chosen according to the different axial lengths of the intraocular lens, in order to avoid postoperative overcorrection.
The clinical observation of second parts of IOL Master after penetrating keratoplasty
objective
IOL Master and A combined with Oculyzer were used to predict the accuracy of IOL Master in PKP after penetrating keratoplasty.
Method
To review 15 cases of Eye Hospital of Shandong province were collected during January 2012 to April 2012 after penetrating keratoplasty (16 eyes), there were 9 males and 6 females, the average age of 34 years (21-48 years), corneal diameter 7.5-8.5mm, uncorrected visual acuity was FC-0.6, all patients with corneal transparence. No obvious corneal graft rejection or rejection have been cured for 3 months, no ocular hyperemia, no obvious inflammatory reaction in the anterior chamber. All patients were treated with IOL and Master500 contact A ultrasound combined with anterior segment analysis system (Oculyzer) artificial lens (IOL) power calculation. The detection rate were compared between the two groups the way of measurement, and the measurement of axial length, corneal curvature, anterior chamber depth difference and correlation, comparing the accuracy of intraocular lens power prediction. Using SPSS17.0 statistical software for data analysis, rate compared with chi square test, paired. The paired t test was used to compare the data. Single factor ANOVA was used to compare the data between groups. The correlation between measured data between two instruments was Pearson correlation analysis, and the difference between P0.05 was statistically significant.
Result
1.IOL Master and A on contact and there was no significant difference in the detection rate of axial length after PKP (X2=1.032, P=0.310).IOL Master PKP on the postoperative corneal curvature detection rate was 56.25%, the detection of Oculyzer corneal curvature rate was 100%, the difference was statistically significant (X2=8.96, P=0.003).
The axial length measured by 2.IOL Master for (23.47 + 1.55) mm, axial length of contact A measured for (23.31 + 1.53) mm, IOL measured by Master axial length than the length of A 0.16mm, there was significant difference between the two groups (t=-4.153, P=0.002), the two are highly correlated (r=0.99, P=0).
The measured 3.IOL Master Km (41.49 + 3.22) D, measured by the Oculyzer Km (43 + 2.41) D, the difference was statistically significant (t=4.571, P=0.006), there is a high correlation between the astigmatism measured.IOL by Master (9.04 + 3.96) D, astigmatism was measured by the Oculyzer (6.70 + 1.64) D, there was significant difference between the two groups (t=-2.469, P=0.057), both of them are highly correlated.
4. contact A measurement of anterior chamber depth (2.77 + 0.39) mm, IOL Master measured the anterior chamber depth (2.82 + 0.44) mm, Oculyzer measured the anterior chamber depth (2.90 + 0.50) mm, 22 three measurement methods were statistically significant (t1,2=-2.388, P= 0.036; t2,3=-3.370, P=0.006; t1,3=-4.225, P=0.001).
5., the IOL degree was calculated according to the SRK/T formula. The IOL Master was measured as (28.18 + 7.61) D, and the contact A A combined Oculyzer was (26.01 + 6.26) D, the difference was statistically significant (t=-5.892, P=0).
IOL Master on penetrating keratoplasty in patients after biological measurements, the corneal curvature detection rate was significantly lower than that of Oculyzer, the measurement of axial length of contact A super accurate, but the accuracy of measurement of corneal curvature was lower than Oculyzer, and should therefore be comprehensive measurement results of two kinds of instruments for penetrating keratoplasty in lens displacement prediction artificial degree after transplantation in clinic at the same time, considering the influence factors of seam in order to select a more appropriate, the intraocular lens.

【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R779.6

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