本文選題：散光 + 人工晶體��； 參考：《安徽醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 背景與目的隨著現(xiàn)代社會科學(xué)的發(fā)展,人們的生活和學(xué)習(xí)條件以及生活模式的改變,使屈光不正的發(fā)病率日益增高。屈光不正是目前世界范圍內(nèi)最常見的眼病。屈光不正的發(fā)病率與人類種族、性別、年齡、地區(qū)、環(huán)境等因素有關(guān)。亞洲是公認(rèn)的屈光不正高發(fā)地區(qū),其中,中國和日本發(fā)病率最高。有關(guān)屈光不正的矯正和治療也一直是處于不斷發(fā)展同時又充滿挑戰(zhàn)的領(lǐng)域。自20世紀(jì)中期開始,屈光性人工晶狀體手術(shù)(refractive intraocular lens surgery)方法不斷改善,并逐步應(yīng)用于臨床。屈光性人工晶狀體手術(shù)的含義是,采用人工晶狀體植入的方法,矯正眼的異常屈光狀態(tài)。它的出現(xiàn)使得不同的年齡層次、不同屈光狀態(tài)的患者施行個性化治療方案成為可能。散光型人工晶體(toric intraocular lens,Toric IOL)的概念于1992年首先由Misawa提出,即在人工晶體的光學(xué)球面上附加一柱鏡。但第一代Toric IOL因旋轉(zhuǎn)穩(wěn)定性差及大切口本身也可產(chǎn)生散光,導(dǎo)致矯正效果差,未能在臨床上得以推廣。后房型有晶體眼散光型人工晶體(visian toric implantable collamer lens,TICL)植入術(shù)作為一種手術(shù)矯治散光的新方法,它不改變原有屈光間質(zhì),有更符合眼內(nèi)生理,屈光矯正范圍廣,術(shù)后視覺癥狀少,可逆等優(yōu)越性。本課題主要通過對近視散光患者行TICL植入術(shù),評價其術(shù)后矯正效果的準(zhǔn)確性、可預(yù)測性、穩(wěn)定性以及手術(shù)的安全性和可能存在的風(fēng)險和并發(fā)癥,進而揭示其在臨床中的應(yīng)用前景。 方法連續(xù)收集2007年4月至2009年6月在安徽醫(yī)科大學(xué)第一附屬醫(yī)院和深圳博愛醫(yī)院行TICL植入術(shù)且臨床資料完整的近視散光患者57例共100只眼。術(shù)前近視度數(shù)為(-4.75～-23.00)D,平均為(-11.225±3.920)D,散光度為(1.25～6.5)D,平均為(2.605±0.923)D,眼軸長平均為(27.527±1.653)mm,前房深度平均為(3.270±0.306)mm。術(shù)后隨訪時間分別在術(shù)后1天、1周、1月、3月、6月、12月和24月,共2年。主要觀察患者手術(shù)前后視力、屈光狀態(tài)、角膜內(nèi)皮細胞計數(shù)、角膜曲率、眼壓、前房、人工晶體柱鏡軸位和自身晶體等情況。對觀察結(jié)果進行統(tǒng)計學(xué)分析,揭示TICL手術(shù)的療效和風(fēng)險。 結(jié)果1、術(shù)后6月,患者殘余散光度為(0～2.5)D,平均(0.778±0.674)D,矯正效果準(zhǔn)確顯著。2、其中有35眼隨訪時間超過2年,術(shù)后6月、12月、24月散光度變化在0.5D以內(nèi),矯正效果穩(wěn)定。3、95%眼裸眼視力(uncorrected visual acuity,UCVA)和99%眼最佳矯正視力(best corrected visual acuity,BCVA)均達到或優(yōu)于術(shù)前BCVA,矯正效果的可預(yù)測性強。4、術(shù)后3月,觀察TICL在眼內(nèi)的旋轉(zhuǎn),其中旋轉(zhuǎn)大于30°眼占2%,96%眼旋轉(zhuǎn)小于15°,說明TICL在眼內(nèi)穩(wěn)定。5、并發(fā)癥情況:7眼眼壓一過性升高,經(jīng)降眼壓治療,1周內(nèi)恢復(fù)正常。1例2眼眼壓持續(xù)升高。1例雙眼眩光。未發(fā)現(xiàn)晶狀體渾濁,色素性青光眼病例。 結(jié)論TICL可提高患者視覺質(zhì)量,矯正散光效果準(zhǔn)確,可預(yù)測性強,并具有良好的旋轉(zhuǎn)穩(wěn)定性。這種新方法的應(yīng)用開辟了屈光手術(shù)新的治療前景。
[Abstract]:Background and objective with the development of modern social science and the change of people's living and learning conditions and life mode, the incidence of ametropia is increasing day by day.Ametropia is currently the most common eye disease worldwide.The incidence of ametropia is related to human race, sex, age, region, environment and other factors.Asia is recognized as an area with high incidence of ametropia, with China and Japan having the highest incidence.Correction and treatment of ametropia has been a growing and challenging field.Since the middle of the 20th century, refractive intraocular lens surgerymethod has been improved and gradually applied in clinical practice.Refractive intraocular lens surgery means that IOL implantation is used to correct the abnormal refractive state of the eye.It makes possible individualized treatment for patients with different age levels and refractive states.The concept of astigmatic intraocular lensi iol was first proposed by Misawa in 1992, that is to say, a cylindrical mirror is attached to the optical sphere of the intraocular crystal.However, the first generation of Toric IOL can produce astigmatism due to poor rotation stability and large incision itself, which leads to poor correction effect and can not be popularized in clinic.Posterior chamber astigmatism intraocular lens implantation is a new method for correction of astigmatism. It does not change the original refractive stroma. It is more in accordance with intraocular physiology, wide range of refractive correction and less postoperative visual symptoms.Reversible and equal superiority.The purpose of this study was to evaluate the accuracy, predictability, stability, safety, possible risks and complications of TICL implantation in myopic astigmatism patients.The prospect of its application in clinic is revealed.Methods from April 2007 to June 2009, 57 myopic astigmatism patients with complete clinical data received TICL implantation in the first affiliated Hospital of Anhui Medical University and Boai Hospital in Shenzhen.The preoperative myopia degree was -4.75 ~ 23.00 渭 D, the average was -11.225 鹵3.920 D., the astigmatism was 1.25 鹵6.5d, the average was 2.605 鹵0.923 D., the average axial length was 27.527 鹵1.653 mm, and the average depth of anterior chamber was 3.270 鹵0.306 mm.The follow-up time was 1 week, 1 month, 3 months, 6 months, 12 months and 24 months, respectively.The visual acuity, refractive state, corneal endothelial cell count, corneal curvature, intraocular pressure, anterior chamber, intraocular lens axis and self-lens were observed before and after operation.The results were statistically analyzed to reveal the efficacy and risk of TICL operation.Results 1. Six months after operation, the residual astigmatism of the patients was 0.75 鹵0.674D, with an average of 0.778 鹵0.674D. The correction effect was significant and accurate. 35 eyes were followed up for more than 2 years, and the astigmatism changed within 0.5D in 6 months, 12 months and 24 months after operation.The corrected effect was stable in 95% of the eyes. The uncorrected visual acuity (UCVA) and the best corrected visual acuity of 99% eyes were up to or superior to those of the preoperative BCVA. The predictive value of the correction effect was strong. 3 months after operation, the rotation of TICL in the eyes was observed.The rotation greater than 30 擄accounted for 2 / 96% of the eyes and the rotation was less than 15 擄, indicating that TICL was stable in the eyes. 5. The complications were transient elevation of IOP in 7 eyes. The IOP in 1 case recovered to normal in 1 week. The IOP continued to increase in 1 case.No lens opacity and pigmented glaucoma were found.Conclusion TICL can improve the visual quality, correct astigmatism, and has good rotation stability.The application of this new method opens up a new prospect for the treatment of refractive surgery.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R779.66

【引證文獻】

相關(guān)碩士學(xué)位論文 前1條

1 陳昌鳳;PRL和ICL兩種后房型人工晶體植入矯治高度近視的臨床比較[D];安徽醫(yī)科大學(xué);2012年

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