本文選題：后房型人工晶狀體 + 對(duì)向透明角膜切口��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)估ICL V4c(implantable collamer lens V4c,ICL V4c)聯(lián)合對(duì)向透明角膜切口矯正近視合并散光的有效性。方法:前瞻性病例研究。選取2015年05月至2016年05月于青島眼科醫(yī)院行ICL V4c植入術(shù)的高度近視合并散光患者20例(40眼),為ICL組,其中男9例,女11例,平均年齡22.5±4.5歲(18~36歲);另外選取同年齡段的20例(40眼)正視眼作為視覺質(zhì)量分析的對(duì)照組,其中男10例,女10例,平均年齡24.8±3.6歲(20~33歲)。ICL組納入標(biāo)準(zhǔn):高度近視患者術(shù)前角膜散光大于1.5D;屈光狀態(tài)穩(wěn)定,不能耐受戴框架眼鏡或角膜接觸鏡;近視度數(shù)為-6.0~-18.0D;前房深度≥2.8mm;角膜內(nèi)皮細(xì)胞計(jì)數(shù)≥2000個(gè)/mm2;無眼表手術(shù)史、角膜病變、白內(nèi)障、青光眼、葡萄膜炎及視網(wǎng)膜病變等。術(shù)前于裂隙燈下在最大角膜屈光力子午線上做角膜緣標(biāo)記,術(shù)中在局部麻醉下距離角膜緣約0.5~1.0mm處做對(duì)向透明角膜切口,其中一個(gè)切口用于植入ICL V4c,另一個(gè)切口用于矯正角膜散光。根據(jù)Jaffe’s矢量分析原理計(jì)算手術(shù)源性角膜散光。檢查結(jié)果包括裸眼視力(uncorrected visual acuity,UCVA),最佳矯正視力(best spectacle-corrected visual acuity,BSCVA),等效球鏡(manifest refraction spherical equivalent,MRSE),角膜曲率,睫狀溝囊腫,高階像差(包括總高階像差、球差、慧差和三葉草),調(diào)制傳遞函數(shù)(modulation transfer function,MTF),屈光矯正者生活質(zhì)量量表(Quality of Life Impact of Refractive Correction,QIRC)。結(jié)果:ICL V4c植入術(shù)后3個(gè)月Log MAR UCVA(-0.05±0.08),Log MAR BSCVA(-0.07±0.06)分別高于術(shù)前Log MAR UCVA(1.26±0.28),Log MAR BSCVA(-0.01±0.09),差異有統(tǒng)計(jì)學(xué)意義(t≥4.55,P0.001)。拱高平均為506.9±179.9um(250~880um)。眼壓由術(shù)前14.8±2.3mm Hg(11~21mm Hg)降到13.9±2.8mm Hg(8~19mm Hg),差別無統(tǒng)計(jì)學(xué)意義(t=1.78,P0.05)。在ICL組,平均角膜散光由術(shù)前2.32±0.59D(1.60~3.67D)降到術(shù)后1.19±0.57D(0.10~2.70D)。Jaffe’s矢量分析法計(jì)算得出手術(shù)源性角膜散光為1.35±0.35D(0.93~2.09D)。在3mm和5mm瞳孔直徑下,除在5mm瞳孔直徑下三葉草,總高階像差、球差、慧差在ICL組和對(duì)照組差別無明顯統(tǒng)計(jì)學(xué)意義(P≥0.13)。在3mm和5mm瞳孔直徑下,5~30c/d空間頻率間,兩組MTF值差別無明顯統(tǒng)計(jì)學(xué)意義(P≥0.12)。ICL植入術(shù)后3個(gè)月QIRC評(píng)分(52.14±1.21)明顯高于術(shù)前(39.57±2.18)�；颊邼M意度水平高,95%患者表示滿意或非常滿意,沒有很不滿意的患者。65%的患者表示術(shù)后早期出現(xiàn)夜間光暈或眩光現(xiàn)象,但隨著時(shí)間延長光暈現(xiàn)象逐漸減輕變得不明顯。在所有患者中,有22眼(55%)發(fā)現(xiàn)睫狀溝囊腫,囊腫直徑≥0.5mm有9只眼(40.9%),囊腫直徑≥1.0mm有2只眼(9.09%)。囊腫主要分布在下方(72.7%)和顳側(cè)(77.3%)。結(jié)論:ICL V4c聯(lián)合對(duì)向透明角膜切口可以有效的矯正近視合并散光,對(duì)視覺質(zhì)量影響較小,對(duì)合并睫狀溝囊腫患者的應(yīng)用具有可行性。
[Abstract]:Objective: to evaluate the efficacy of ICL V4c(implantable collamer lens V 4 C combined with ICL 4 c in the correction of myopia with astigmatism through a transparent corneal incision. Methods: prospective case study. From May 2015 to May 2016, 20 patients with high myopia combined with astigmatism underwent ICL V4c implantation in Qingdao Ophthalmology Hospital. They were selected as ICL group, including 9 males and 11 females. The mean age was 22. 5 鹵4. 5 years old and 18 / 36 years old. Another 20 cases (40 eyes) of the same age group were selected as the control group for visual quality analysis, including 10 males and 10 females. The mean age was 24.8 鹵3.6 years (20 / 33). The ICL group included: preoperative corneal astigmatism was greater than 1.5 D in patients with high myopia, and the refractive state was stable and could not withstand framing glasses or contact lenses. Myopia was -6.0 ~ 18.0D, anterior chamber depth 鈮，

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