發(fā)布時(shí)間：2018-07-14 20:30

【摘要】： 一、不同角度白內(nèi)障透明角膜切口構(gòu)型分析 目的 運(yùn)用前節(jié)光相干斷層掃描儀(anterior segment optical coherence tomography AS-OCT)探討采用不同角度構(gòu)建的3.2mm透明角膜切口構(gòu)型(clear corneal incision CCI)對(duì)白內(nèi)障切口密閉性的影響。 方法 選擇年齡相關(guān)性白內(nèi)障患者63例(73眼),做3.2mmCCI,行白內(nèi)障超聲乳化聯(lián)合折疊型人工晶體植入術(shù)。術(shù)前1天、術(shù)后1天、1周及1個(gè)月應(yīng)用AS-OCT對(duì)角膜切口區(qū)進(jìn)行掃描。切口表面的切線與外口、內(nèi)口連線的交角作為切口角度,依據(jù)切口角度范圍的不同分為兩組,≤45°為對(duì)照組,共32例(38眼)45。為實(shí)驗(yàn)組,共31例(35眼)。 結(jié)果 (1)對(duì)照組和實(shí)驗(yàn)組切口角度分別為(31.6±5.4)°和(54.3±5.5)。； (2)術(shù)后第1天、1周及1個(gè)月兩組切口處角膜厚度、切口長度、切口未愈合長度與全長的比例及內(nèi)口哆開的差異均有統(tǒng)計(jì)學(xué)意義(P均0.01)； (3)兩組后彈力層脫離的差異無統(tǒng)計(jì)學(xué)意義(P均0.05)； (4)兩組切口外口的閉合率均為100%。 結(jié)論 (1) AS-OCT是一種非接觸式的、有效評(píng)估白內(nèi)障CCI形態(tài)改變的方法。 (2)白內(nèi)障超聲乳化術(shù)CCI角度大,長度短,將不利于切口(尤其是內(nèi)口)密閉及愈合。 (3)理想的切口角度有利于構(gòu)建良好的切口密閉性,降低眼表與前房溝通的可能性,避免眼表細(xì)菌進(jìn)入前房,有助于減少白內(nèi)障術(shù)后眼內(nèi)炎的發(fā)生 二、不同核分級(jí)白內(nèi)障術(shù)后透明角膜切口構(gòu)型分析 目的 應(yīng)用OCT研究不同核分級(jí)白內(nèi)障超聲乳化術(shù)后CCI的構(gòu)型變化及術(shù)前核硬度不同對(duì)術(shù)后切口愈合的影響。 方法 選擇年齡相關(guān)性白內(nèi)障患者82例(93眼)做3.2mm CCI,行白內(nèi)障超聲乳化術(shù)聯(lián)合人工晶體植入術(shù)。依據(jù)Emery和Little晶狀體核硬度分級(jí)標(biāo)準(zhǔn)：將所有病例分為三組,Ⅱ級(jí)核26例(31眼),Ⅲ級(jí)核29例(31眼),Ⅳ31例(31眼)。術(shù)前1d、術(shù)后1d、術(shù)后1月及3個(gè)月采用AS-OCT掃描全部角膜及切口區(qū)域,測(cè)量不同區(qū)域角膜厚度,記錄切口內(nèi)外口哆開、水皰及后彈力層脫離情況。定量資料進(jìn)行單項(xiàng)及兩因素重復(fù)測(cè)量的方差分析,定性資料進(jìn)行χ2檢驗(yàn)。 結(jié)果 (1)術(shù)前術(shù)后不同時(shí)間點(diǎn)，不同區(qū)域(中央角膜、距頂點(diǎn)3mm處上方角膜、距頂點(diǎn)3mm處下方角膜,切口區(qū)域角膜)的角膜厚度有統(tǒng)計(jì)學(xué)差異(F=306.23,288.34,52.17,957.28，P均=0.00)； (2)不同核分級(jí)組中央角膜厚度、距頂點(diǎn)3mm處上方角膜厚度、切口區(qū)域角膜厚度組間差異有統(tǒng)計(jì)學(xué)意義(F=3.59,4.43,39.67，P=0.02,0.01,0.00)； (3)術(shù)后時(shí)間與核硬度之間有明顯的交互效應(yīng),(F=59.27,11.62,9.05，25.65,P均=0.00)。術(shù)后1周,三組上皮水皰、切口內(nèi)口哆開、內(nèi)皮水泡的發(fā)生率最高,且組間差異有統(tǒng)計(jì)學(xué)意義(χ2=8.78,8.07，11.82,P=0.00,0.02，0.00)； (4)術(shù)后1個(gè)月三組間切口內(nèi)口哆開及內(nèi)皮水泡的發(fā)生率差異有統(tǒng)計(jì)學(xué)意義(χ2=10.68，15.29，P=0.01,0.02,0.00),術(shù)后3月均消退。 (5)本研究發(fā)現(xiàn)術(shù)后1個(gè)月及3個(gè)月時(shí)切口內(nèi)口愈合不良1例。 結(jié)論 (1)白內(nèi)障超聲乳化術(shù)導(dǎo)致不同區(qū)域的角膜厚度均有不同程度的增加,以術(shù)后1d最顯著,其中切口區(qū)域的角膜厚度增加最明顯,并且術(shù)后3個(gè)月除了切口區(qū)域的水腫未完全消退,其他區(qū)域的角膜均發(fā)生了可逆性的改變。 (2)不同區(qū)域角膜厚度隨時(shí)間的變化趨勢(shì)不同,其中角膜中央水腫消退最快,其次為距角膜頂點(diǎn)3mm處下方區(qū)域及距頂點(diǎn)3mm上方區(qū)域,且這三個(gè)區(qū)域的角膜水腫均在術(shù)后3個(gè)月完全消退。 (3)本研究發(fā)現(xiàn)了1例Ⅳ級(jí)核患者出現(xiàn)切口內(nèi)口愈合不良,其余切口愈合良好。Ⅲ級(jí)核和Ⅳ級(jí)核患者術(shù)后切口內(nèi)口哆開,上皮水皰,內(nèi)皮水皰及后彈力層脫離完全愈合慢于Ⅱ級(jí)核。 三、不同位置白內(nèi)障透明角膜切口構(gòu)型及角膜波前像差分析 目的 探討白內(nèi)障超聲乳化術(shù)后不同部位透明角膜切口CCI構(gòu)型及角膜波前像差的變化。 方法 選擇年齡相關(guān)性白內(nèi)障患者91例(91只右眼),依據(jù)切口位置不同分為兩組,顳側(cè)10點(diǎn)位切口組,共46例(46眼),上方12點(diǎn)位切口組,共45例(45眼)。術(shù)前1d、術(shù)后1d、1個(gè)月及3個(gè)月分別進(jìn)行AS-OCT掃描,術(shù)后1個(gè)月及3個(gè)月進(jìn)行裸眼視力(uncorrected visual acuity，，UCVA)、最佳矯正視力(best corrected visual acuity, BCVA)及角膜波前像差檢查。 結(jié)果 (1)術(shù)后兩組切口區(qū)域角膜厚度增值、切口角度及切口長度差異均有統(tǒng)計(jì)學(xué)意義(P均0.05)； (2)術(shù)后早期切口區(qū)域內(nèi)口哆開發(fā)生率差異均有統(tǒng)計(jì)學(xué)意義(P均0.05)； (3)術(shù)后1d兩組上皮水皰、內(nèi)皮水皰及后彈力層脫離發(fā)生率的差異有統(tǒng)計(jì)學(xué)意義(P均0.05)； (4)兩組UCVA、BCVA、散光、慧差及三葉草差異均有統(tǒng)計(jì)學(xué)意義(P均0.05)。 結(jié)論 (1)術(shù)后早期,白內(nèi)障超聲乳化術(shù)透明角膜顳側(cè)切口較上方切口局部水腫輕,其構(gòu)型更有利于形成密閉性切口,降低眼內(nèi)炎的危險(xiǎn)因素； (2)術(shù)后遠(yuǎn)期,顳側(cè)切口所致手術(shù)源性散光小,角膜波前像差小,視覺質(zhì)量好,是較理想的手術(shù)切口部位。
[Abstract]:Analysis of the configuration of transparent corneal incision at different angles
objective
The effect of 3.2mm transparent corneal incision (clear corneal incision CCI) on the closure of the cataract incision was investigated by anterior segment optical coherence tomography AS-OCT using the anterior segment optical coherence tomography (optical coherence tomography AS-OCT).
Method
63 cases (73 eyes) of patients with age-related cataract (73 eyes) were performed 3.2mmCCI with cataract phacoemulsification combined with foldable intraocular lens implantation. The corneal incision area was scanned by AS-OCT for 1 days before operation, 1 days, 1 weeks and 1 months after operation. The cut angle of the incision surface and the intersection angle of the inner mouth line were used as the incision angle, according to the angle range of the incision. The patients were divided into two groups, with a total of 32 cases (38 eyes) and a total of 32 cases (38 eyes), with a total of 31 cases (35 eyes).
Result
(1) the incision angles of the control group and the experimental group were (31.6 + 5.4) degrees and (54.3 + 5.5) respectively.
(2) the corneal thickness at the first, 1 and 1 months after the operation, the length of the incision, the length of the incision, the proportion of the length of the incision and the total length of the incision and the difference of the inner mouth were statistically significant (P 0.01).
(3) there was no significant difference between the two groups of posterior elastic detachment (P = 0.05).
(4) the closure rate of the two groups of incisional incision was 100%.
conclusion
(1) AS-OCT is a non-contact and effective method to evaluate the morphological changes of CCI in cataract.
(2) cataract phacoemulsification has a large CCI angle and short length, which will not be conducive to airtight and healing of incision (especially internal opening).
(3) the ideal incision angle is beneficial to the construction of good closure of the incision, the possibility of reducing the communication between the eye surface and the anterior chamber, to avoid the entry of ocular surface bacteria into the anterior chamber, and to reduce the incidence of endophthalmitis after cataract surgery.
Two. Analysis of clear corneal incision configuration after cataract surgery with different nuclear grades.
objective
OCT was used to study the changes of CCI configuration after different phacoemulsification and the effect of different preoperative nuclear hardness on wound healing.
Method
82 cases (93 eyes) of age related cataract were selected to do 3.2mm CCI and cataract phacoemulsification combined with intraocular lens implantation. According to the standard of Emery and Little lens nuclear hardness classification, all cases were divided into three groups, 26 cases (31 eyes), 29 cases of grade III (31 eyes), 31 cases (31 eyes). Preoperative 1D, postoperative 1D, postoperative January and 3 months postoperatively. All corneal and incisional regions were scanned with AS-OCT. The corneal thickness in different regions was measured, the opening of the incision, the blister and the detachment of the posterior elastic layer were recorded. The quantitative data were analyzed by the single and two factors repeated measurements, and the qualitative data were tested by the chi 2 test.
Result
(1) there were significant differences in corneal thickness between different regions (central cornea, upper cornea at the apex 3mm, lower cornea at the apex 3mm, and cornea of the incision area) before and after the operation (F=306.23288.34,52.17957.28, P =0.00).
(2) the thickness of the central cornea, the thickness of the corneal thickness above the apex 3mm and the corneal thickness in the incision area were statistically significant (F=3.59,4.43,39.67, P=0.02,0.01,0.00).
(3) there was an obvious interaction effect between the postoperative time and the nuclear hardness (F=59.27,11.62,9.05,25.65, P =0.00). 1 weeks after the operation, the three groups of epithelial blister, the incision in the mouth opened, the incidence of endothelial vesicles was the highest, and there was a statistically significant difference between the groups (x 2=8.78,8.07,11.82, P= 0.00,0.02,0.00).
(4) 1 months after operation, there was a significant difference in the incidence of incision opening and endothelia blisters between the three groups (2=10.68,15.29, P=0.01,0.02,0.00), and all of them subsided in March.
(5) there were 1 cases of poor healing of incisions at 1 and 3 months after operation.
conclusion
(1) cataract phacoemulsification resulted in a different degree of corneal thickness in different regions, with the most significant postoperative 1D, the most obvious increase in the corneal thickness in the incision area, and 3 months after the operation, the edema in the incision area was not completely subsided, and the cornea of the other regions had a reversible change.
(2) the variation trend of corneal thickness in different regions was different with time, in which the central corneal edema subsided most quickly, followed by the region below the corneal vertex 3mm and the area above the apex of 3mm, and the corneal edema in these three regions all subsided in 3 months after the operation.
(3) in this study, 1 cases of grade IV Nuclear patients were found to have poor healing in the incision, and the rest of the incision healed well. The incision of the incision in the third class nucleus and grade IV nucleus, the epithelial blister, the endothelial blister, and the complete healing of the posterior elastic layer were slower than the class II nucleus.
Three, the different types of transparent corneal incision configuration and corneal wavefront aberration in different locations.
objective
Objective to investigate the changes of CCI configuration and corneal wavefront aberration in different parts of clear corneal incision after phacoemulsification.
Method
91 cases (91 right eyes) of patients with age-related cataract were divided into two groups according to the location of the incision, 10 point incision in the temporal side, 46 cases (46 eyes), 12 points in the incision group, and 45 cases (45 eyes). The preoperative 1D, 1D, 1 months and 3 months after the operation were carried out by AS-OCT scanning respectively, and the naked eye (uncorrected visual acuity) was carried out 1 months and 3 months after the operation. (UCVA), best corrected visual acuity (BCVA) and corneal wavefront aberration test.
Result
(1) there were significant differences in corneal thickness, incision angle and incision length between the two groups (P 0.05).
(2) there were significant differences in the incidence of mouth opening in the early incision area (P = 0.05).
(3) there was a significant difference in the incidence of epithelial blister, endothelial blister and posterior elastic detachment between group 1D and group two (P 0.05).
(4) there were significant differences in two groups of UCVA, BCVA, astigmatism, coma and Trifolium (P 0.05).
conclusion
(1) early postoperative, cataract phacoemulsification, transparent corneal temporal incision is less local edema than the upper incision, and its configuration is more conducive to the formation of closed incision and reduce the risk factors of endophthalmitis.
(2) long term postoperative, temporal astigmatism resulted in low surgical astigmatism, small wavefront aberration and good visual quality.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R779.66

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