本文選題：白內(nèi)障　切入點(diǎn)：IOL混濁　出處：《浙江大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： [目的] 通過病例回顧和相關(guān)基礎(chǔ)研究,總結(jié)和分析白內(nèi)障術(shù)后IOL混濁的臨床表現(xiàn)、診斷和治療方法,探討其研究方法、發(fā)病機(jī)制、診斷標(biāo)準(zhǔn)和治療思路,從而為IOL混濁的預(yù)防、早期診斷和合理治療提供依據(jù)。 [方法] 統(tǒng)計(jì)2002年1月至2009年8月期間于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院眼科中心住院病人中診斷為IOL混濁并接受人工晶體置換術(shù)的6例病人的臨床資料,并運(yùn)用裂隙燈顯微鏡觀察、掃描電子顯微鏡(SEM)觀察和X線衍射對部分取出的混濁IOL進(jìn)行臨床病理學(xué)研究。運(yùn)用美國國立醫(yī)學(xué)圖書館Pubmed數(shù)據(jù)庫,輸入關(guān)鍵詞(白內(nèi)障、人工晶體混濁、超聲乳化、人工晶體植入、羥基磷灰石、水凝膠、丙烯酸酯、硅凝膠、人工晶體置換)檢索1980-2010年間在線文獻(xiàn)數(shù)據(jù),全面剖析IOL混濁的發(fā)病機(jī)制、臨床表現(xiàn)、診斷和治療方法。 [結(jié)果] 2002年1月至2009年8月期間本院住院患者中診斷為IOL混濁患者共6例(6只眼),男3例、女3例,平均年齡73.3(68-80)歲,右眼5例、左眼1例,平均IOL植入至發(fā)生混濁時(shí)間為68(12-122)個(gè)月。3例分別伴有葡萄膜炎和高度近視等眼部疾病,6例均分別伴有高血壓、糖尿病、風(fēng)濕病、心律不齊、肺結(jié)核等疾病,1例被誤診為后發(fā)障并接受YAG激光治療。所有患者均接受了IOL置換術(shù)治療,術(shù)前和術(shù)后第一天平均視力分別為0.21±0.09和0.50±0.21,配對t檢驗(yàn)P=0.0130.05,差異具有統(tǒng)計(jì)學(xué)意義。發(fā)生混濁的IOL均為水凝膠材料,生產(chǎn)批次集中在2000-2002年間。對其中1枚取出的IOL進(jìn)行裂隙燈觀察示后表面哈氣樣混濁,掃描電鏡下觀察示混濁為IOL光學(xué)部表面排列疏松紊亂的結(jié)晶樣小體沉積物,另1枚混濁的IOL表面沉積物X-射線衍射提示混濁IOL有一水磷酸鈣物質(zhì)沉積。 [結(jié)論] (1)IOL混濁僅發(fā)生于極少數(shù)患者,多見于水凝膠等材料,其本質(zhì)主要為以鈣磷混合物為主的各種沉積物沉積于IOL表面。 (2)IOL混濁易被誤診為后發(fā)障等疾病并接受錯(cuò)誤的治療。 (3)IOL置換術(shù)是有效的治療方式。
[Abstract]:[purpose]. The clinical manifestations, diagnosis and treatment of IOL opacification after cataract surgery were summarized and analyzed through case review and related basic research. The research methods, pathogenesis, diagnostic criteria and treatment ideas were discussed, so as to prevent IOL opacification. Early diagnosis and reasonable treatment provide basis. [methods]. From January 2002 to August 2009, the clinical data of 6 patients who were diagnosed as IOL opacity and underwent intraocular lens replacement in the eye center of the second affiliated Hospital of Zhejiang University Medical College were analyzed and observed by slit lamp microscope. Scanning electron microscope (SEM) observation and X-ray diffraction were used to study the clinicopathology of partially extracted opacity IOL. The key words (cataract, intraocular lens opacity, phacoemulsification, phacoemulsification) were inputted by the Pubmed database of the National Library of Medicine. Intraocular lens implantation, hydroxyapatite, hydrogel, acrylate, silica gel, intraocular lens replacement (IOL) were searched online from 1980 to 2010 to analyze the pathogenesis, clinical manifestation, diagnosis and treatment of IOL opacity. [results]. From January 2002 to August 2009, 6 patients (3 males and 3 females) were diagnosed as IOL opacification, with an average age of 73.3 years (68-80), right eye (5 cases) and left eye (1 case). The mean time of IOL implantation to opacity was 68 ~ 12 ~ 122) months. 3 cases were associated with uveitis and high myopia, 6 cases with hypertension, diabetes, rheumatism, arrhythmia, etc. One patient with pulmonary tuberculosis and other diseases was misdiagnosed as a posterior obstacle and received YAG laser treatment. All patients were treated with IOL replacement. The mean visual acuity was 0.21 鹵0.09 and 0.50 鹵0.21 before operation and the first day after operation, respectively. The difference was statistically significant in paired t test (P < 0.0130.05). The opacity of IOL was hydrogel material, and the mean visual acuity was 0.21 鹵0.09 and 0.50 鹵0.21, respectively. The production batches were concentrated between 2000 and 2002. Slit lamp was used to observe the hazy turbidity on the back surface of one of the IOL samples, and scanning electron microscope showed that the turbidity was the deposit of crystalline bodies with loose arrangement on the surface of the optical part of IOL. Another opacity of IOL surface sediment X-ray diffraction indicates that opacity IOL has calcium phosphate monohydrate deposition. [conclusion]. IOL turbidity occurred only in a few patients and was mainly found in hydrogels and other materials. The essence of the turbidity was the deposition of various sediments mainly composed of calcium and phosphorus mixtures on the surface of IOL. IOL opacification is easily misdiagnosed as a disease such as posterior obstacle and received wrong treatment. IOL replacement is an effective treatment.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R779.66

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