本文選題：晶體 + 人工��； 參考：《濟南大學》2013年碩士論文

【摘要】：目的 通過研究兒童白內(nèi)障患者植入多焦點人工晶體的手術適應證和觀察植入術后初期的臨床效果，為兒童白內(nèi)障患者的臨床治療提供參考依據(jù)。 方法 采用前瞻性病例研究收集2011年1月至2013年3月因“先天性白內(nèi)障”或“發(fā)育性白內(nèi)障”于我院行手術治療且資料完整的22例27只眼。其中包括男13例，女9例；年齡6-14歲，平均9.5歲。21眼為繞核性白內(nèi)障，6眼為核性白內(nèi)障，全部患者行白內(nèi)障超聲乳化吸除聯(lián)合折疊式人工晶體植入手術治療。按照植入人工晶體的類型分為多焦點人工晶體組（multifocal intraocular lens,MIOL組）和單焦點人工晶體組（single focus intraocular lens,SIOL組）。MIOL組12例15眼，植入衍射多焦點人工晶體AMO Tecnis ZMB00；SIOL組10例12眼，植入單焦點球面人工晶體Bausch＆Lomb Akreos Adapt。術前均行角膜曲率、角膜散光、眼軸、角膜內(nèi)皮、瞳孔直徑測量，IOL測算，B超、VEP等檢查。隨訪12mon后對比MIOL組和SIOL組的未矯正遠、近視力，中間視力、最佳矯正遠、近視力，遠視矯正度數(shù)下近視力，對比度視力、等效球鏡、散光、眼軸、瞳孔直徑、立體視銳度、偽調(diào)節(jié)力，脫鏡率、發(fā)放視覺癥狀及滿意度調(diào)查問卷，記錄術后并發(fā)癥。采用SPSS17.0統(tǒng)計軟件進行數(shù)據(jù)分析，兩組數(shù)據(jù)的比較若均符合正態(tài)分布采用兩個獨立樣本的t檢驗，若不符合則采用兩個獨立樣本的非參數(shù)檢驗Mann-Whitney U檢驗，成組資料的比較采用多個獨立樣本的非參數(shù)檢驗Kruskal-Wallis H檢驗，率的比較行Fisher’s卡方檢驗，均以P0．05為差異有統(tǒng)計學意義。 結果 1.術前MIOL組和SIOL組的年齡、視力、眼軸、角膜散光、瞳孔直徑、IOL屈光度比較差異均無統(tǒng)計學意義（分別為t=0.00，z=-0.074，t=0.081，t=-0.472，t=-0.458，t=1.296），p0.05（見表2）。性別構成比差異亦無統(tǒng)計學意義，p0.05（見表3）。 2．術后MIOL組和SIOL組的未矯正近視力、中間視力、遠視矯正度數(shù)下近視力、近附加度數(shù)比較差異均有統(tǒng)計學意義（分別為z=-3.725,z=-2.327,z=-2.735,z=-4.431）,p0.05。而未矯正遠視力、最佳矯正遠視力、最佳矯正近視力均無統(tǒng)計學意義（分別為z=-0.125,t=0.303,z=-1.015）,p0.05。 3．MIOL組和SIOL組患者隨著對比度的下降，視力均呈下降趨勢；隨著背景亮度的下降，視力變化不大。見表5-表8 3.1對MIOL組和SIOL組患者在同一背景亮度下（250cd/m2和25cd/m2）各對比度的視力（100%，25%，10%，5%）進行比較，差異均有統(tǒng)計學意義，p0.05（X2值分別為46.86,34.59,47.38,34.99）。組間兩兩比較,結果顯示差異均無統(tǒng)計學意義，p0.05（分別為t=-0.586，t=-1.649，z=-1.026，z=-1.691，t=-0.625，t=-1.531，z=-0.781，z=-1.222）。見表5，表6 3.2對同一對比度下不同的背景亮度時的視力行組內(nèi)兩兩比較，結果顯示差異均無統(tǒng)計學意義，p0.05。見表7，表8 4.兩組患者的等效球鏡、角膜散光、眼軸及瞳孔直徑差異均無統(tǒng)計學意義，p0.05。（分別為t=-0.229,z=-1.868,t=-2.021,z=-0.476）見表9 5．兩組患者術后未矯正遠立體視比較差異無統(tǒng)計學意義（p0.05）,但MIOL組立體視良好者所占的比率（41.7%）比SIOL組（30%）要高。兩組患者未矯正近視力和最佳矯正近立體視比較差異有統(tǒng)計學意義（p0.05）。見表10,11 6．多焦點IOL偽調(diào)節(jié)力平均值為2.50±0.37D，SIOL組的平均值為0.92±0.31D，二者比較差異有統(tǒng)計學意義（t=11.97,p0.05）。 7．MIOL組視遠脫鏡率為75%，SIOL組為60%，二者比較差異無統(tǒng)計學意義，p0.05。MIOL組視近脫鏡率為91.7%，SIOL組為10%，兩組之間差異有統(tǒng)計學意義，p0.05。MIOL組完全脫鏡率為75%，SIOL組為10%，二者比較差異亦有統(tǒng)計學意義，p0.05。見表12 8．術后12mon行問卷調(diào)查評分，其中兩組之間的視覺不良癥狀評分和看遠滿意度評分比較差異均無統(tǒng)計學意義，，p0.05。而兩組之間看近滿意度評分比較差異有統(tǒng)計學意義，p0.05。見表13 9. MIOL組的后發(fā)性白內(nèi)障的發(fā)生率為20%，低于SIOL組的33%，但二者比較差異并無統(tǒng)計學意義，p0.05。見表14,15 結論 兒童白內(nèi)障患者植入多焦點人工晶體可以獲得較好的全程視力，立體視覺更好，脫鏡率更高且未出現(xiàn)明顯的視覺癥狀和并發(fā)癥。因此，對于6-14歲兒童植入多焦點人工晶體或許是個不錯的選擇。但由于本實驗觀察例數(shù)較少、隨訪時間較短，遠期效果有待于考證。多焦點人工晶體適應證控制較嚴格,術后需要相當長的學習過程且價格較高，因而限制了在兒童白內(nèi)障患者中的廣泛應用。
[Abstract]:objective
To provide reference basis for the clinical treatment of children with cataract by studying the surgical indications of implantation of multi focal intraocular lens in children with cataract and observing the clinical effect of the early stage after implantation.
Method
A prospective case study was used to collect 22 cases of 27 eyes from January 2011 to March 2013 with "congenital cataract" or "developmental cataract" in our hospital with complete data, including 13 men, 9 women, 6-14 years of age and 9.5 years of.21 eyes with nuclear white barrier and 6 eyes as nuclear cataract. All the patients were in white. Phacoemulsification combined with foldable intraocular lens implantation was performed. According to the types of implanted intraocular lenses, 12 cases (15 eyes) were divided into multi focus intraocular lens group (multifocal intraocular lens, MIOL group) and single focus intraocular lens group (single focus intraocular lens, SIOL group), and the multifocal intraocular lens was implanted into the multifocal intraocular lens. 00; in group SIOL, 10 cases with 12 eyes were implanted with single focus spherical intraocular lens, Ba & Akreos Adapt., before operation, corneal curvature, corneal astigmatism, ocular axis, corneal endothelium, pupil diameter measurement, IOL calculation, B-ultrasound, VEP and other examinations. Follow up 12mon compared the uncorrected distance between the MIOL group and the SIOL group, the near vision, the middle vision, the best correction far, the near vision, and the hyperopia. Near vision, contrast vision, equivalent eyesight, astigmatism, astigmatism, eye axis, pupil diameter, stereoacuity, pseudoracuity, removal of mirror, visual symptoms and satisfaction questionnaires were issued, and postoperative complications were recorded. The data were analyzed by SPSS17.0 software, and the comparison of the two groups of data were in accordance with the normal distribution of two independent samples. T test, if nonconforming, the non parametric test of Mann-Whitney U test with two independent samples, the comparison of group data using multiple independent samples of non parametric test of Kruskal-Wallis H test, the comparison of the rate of Fisher 's chi square test, all with P0.05 as a statistically significant difference.
Result
1. there were no significant differences in age, vision, eye axis, corneal astigmatism, pupil diameter, and IOL diopter in group MIOL and SIOL before operation (t=0.00, z=-0.074, t=0.081, t=-0.472, t=-0.458, t=1.296), P0.05 (see Table 2). There was no significant difference in sex composition ratio, P0.05 (see table 3).
2. uncorrected near vision, middle vision, and hyperopia correction degree of near visual acuity in group MIOL and group SIOL after operation were statistically significant (z=-3.725, z=-2.327, z=-2.735, z=-4.431), p0.05. without correction of far vision, the best correction of far vision, and the best correction of near vision were not statistically significant (z=-0.125, respectively). T=0.303, z=-1.015), p0.05.
In group 3.MIOL and group SIOL, the visual acuity decreased with the decrease of contrast. The visual acuity changed little with the decrease of background brightness. See table 5- Table 8.
3.1 the differences were statistically significant between group MIOL and group SIOL (100%, 25%, 10%, 5%) at the same background brightness (100%, 25%, 10%, 5%). P0.05 (X2 value was 46.86,34.59,47.38,34.99). 22 comparison between groups showed that the difference was not statistically significant, P0.05 (t=-0.586, t=-1.649, z=-1.026, z). =-1.691, t=-0.625, t=-1.531, z=-0.781, z=-1.222). See Table 5, table 6.
3.2 the comparison of 22 groups of visual acuity in the same contrast with different background brightness showed no significant difference. P0.05., see Table 7, table 8.
4. there were no significant differences in the equivalent sphere, corneal astigmatism, ocular axis and pupil diameter in the two groups, and p0.05. (t=-0.229, z=-1.868, t=-2.021, z=-0.476) were found in Table 9.
5. in the two groups, there was no significant difference in postoperative stereopsis (P0.05), but the ratio of stereoscopic vision in group MIOL (41.7%) was higher than that in group SIOL (30%). There was significant difference between the two groups of patients without correction of near vision and the best correction of stereopsis (P0.05). See table 10,11
6. the multifocal IOL pseudo adjustment power averaged 2.50 + 0.37D, and the average value of SIOL group was 0.92 + 0.31D, and the difference between the two groups was statistically significant (t=11.97, P0.05).
The rate of vision removal in group 7.MIOL was 75% and that of group SIOL was 60%. There was no statistical difference between the two groups. The visual angle removal rate of group p0.05.MIOL was 91.7%, group SIOL was 10%, the difference between the two groups was statistically significant, the rate of complete mirror removal in the p0.05.MIOL group was 75%, the group SIOL was 10%, and the two were also statistically significant, p0.05. see table 12.
After 8. 12mon, a questionnaire survey was conducted. There was no significant difference in the scores of visual adverse symptoms between the two groups and the scores of far satisfaction scores. There was a significant difference between the two groups in the two groups, while the difference between the two groups was statistically significant, and that of table 13 was 13.
9. the incidence of posterior capsule opacification in group MIOL was 20%, lower than 33% in group SIOL, but there was no significant difference between the two groups, p0.05. 14,15
conclusion
The implantation of multi focal intraocular lenses for children with cataract can obtain better visual acuity, better stereoscopic vision, higher rate of removal of mirror and no obvious visual symptoms and complications. Therefore, it may be a good choice for 6-14 year old children to implant multi focus intraocular lens. The long-term effect remains to be examined. The multifocal intraocular lens (IOL) indications are strictly controlled, and a long learning process and a higher price are required after the operation, thus limiting the widespread use of cataract in children.
【學位授予單位】：濟南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R779.66

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