發(fā)布時(shí)間：2018-08-12 19:45

【摘要】：第一部分單純老年性白內(nèi)障超聲乳化術(shù)后黃斑中心凹視網(wǎng)膜厚度及視網(wǎng)膜敏感度變化 目的：觀察單純老年性白內(nèi)障患者在超聲乳化吸除術(shù)后黃斑中心凹厚度以及視功能變化情況,探討黃斑結(jié)構(gòu)變化與視功能之間關(guān)系。 方法：使用光學(xué)相干斷層掃描(Optical Coherence Tomography, OCT)聯(lián)合微視野儀(Microperimetry-1,MP-1)對128例單純老年性白內(nèi)障患者在超聲乳化吸除術(shù)前、術(shù)后1周、術(shù)后1月以及術(shù)后3月進(jìn)行檢查,觀察患者術(shù)眼黃斑中心凹厚度(Foveal Thickness, FT),黃斑中心10°范圍視網(wǎng)膜平均光敏感度(MeanSensitivity, MS)以及最佳矯正視力(Best Corrected Visual Acuity,BCVA)的變化,分析超聲乳化術(shù)對視網(wǎng)膜厚度影響。 結(jié)果：128例單純老年性白內(nèi)障患者OCT檢查術(shù)前平均FT為231.7±8.4μm,術(shù)后1月為234.3±18.2μm,術(shù)后1月較術(shù)前有顯著性差異,P0.05；術(shù)后3月平均FT較術(shù)前無統(tǒng)計(jì)學(xué)差異,P0.05。MP-1檢測術(shù)前平均MS為9.7±3.3dB,術(shù)后1月為15.1±4.5dB,術(shù)后1月較術(shù)前有顯著差異P0.05。術(shù)前BCVA0.3的患者有51例,0.4～0.6的患者77例,術(shù)前平均LogMAR BCVA為0.43±0.22,術(shù)后1月時(shí)BCVA在0.4～0.6患者20例,≥0.7的患者108例,術(shù)后1月平均LogMAR BCVA為0.11±0.13,術(shù)后1月較術(shù)前有顯著性差異,P0.05。 結(jié)論：白內(nèi)障超聲乳化吸除并人工晶體植入術(shù)對單純老年性白內(nèi)障患者眼底影響小,術(shù)后視網(wǎng)膜光敏感度和最佳矯正視力均較術(shù)前均有明顯提高。 第二部分糖尿病合并白內(nèi)障超聲乳化術(shù)后黃斑中心凹視網(wǎng)膜厚度及視網(wǎng)膜敏感度變化 目的：觀察糖尿病合并白內(nèi)障患者在超聲乳化吸除術(shù)后黃斑中心凹厚度以及視功能變化情況,探討黃斑結(jié)構(gòu)變化與視功能之間關(guān)系。 方法：使用OCT聯(lián)合MP-1對102例糖尿病合并白內(nèi)障患者在超聲乳化吸除術(shù)前、術(shù)后1周、術(shù)后1月以及術(shù)后3月進(jìn)行檢查,觀察患者術(shù)眼FT、黃斑中心10。范圍視網(wǎng)膜MS以及BCVA的變化,分析超聲乳化術(shù)對糖尿病患者視網(wǎng)膜厚度及視功能的影響。 結(jié)果：將第一部分患者作為對照組,糖尿病組患者兩個(gè)亞組中5年以上亞組術(shù)前平均FT為234.9±14.4μm較對照組有顯著性差異,P0.05。兩個(gè)亞組術(shù)后1月、術(shù)后3月平均FT較術(shù)前均有顯著增厚,P0.05；兩個(gè)亞組術(shù)后1月平均FT對照組有顯著性增厚,P0.05。兩個(gè)亞組術(shù)后1周、術(shù)后1月以及術(shù)后3月平均MS較術(shù)前均有顯著提高,P0.05。其中5年以上亞組術(shù)后1月平均MS較對照組有顯著性差異,P0.05。兩個(gè)亞組術(shù)后1月LogMAR BCVA較術(shù)前均有顯著降低,P0.05。術(shù)后1月發(fā)生白內(nèi)障術(shù)后人工晶體眼黃斑囊樣水腫(PseudophakicCystoid Macular Edema, PCME)患者共5例,其中5年以上病程組4例。 結(jié)論：對糖尿病合并白內(nèi)障患者,超聲乳化手術(shù)導(dǎo)致PCME的可能性較大,且可能會(huì)導(dǎo)致視功能下降,且病程較長患者影響較病程較短患者更明顯,術(shù)后視功能恢復(fù)所需時(shí)間更長。 第三部分高度近視合并白內(nèi)障超聲乳化術(shù)后黃斑中心凹視網(wǎng)膜厚度及視網(wǎng)膜敏感度變化 目的：光學(xué)相干斷層掃描(Optical Coherence Tomography, OCT)聯(lián)合微視野MP-1儀檢測單純老年性白內(nèi)障患者、糖尿病及高度近視合并白內(nèi)障患者在超聲乳化吸除術(shù)后黃斑結(jié)構(gòu)變化,并探與視功能的關(guān)系。 方法：67例高近合并白內(nèi)障患者在超聲乳化吸除術(shù)前、術(shù)后1周、術(shù)后1月以及術(shù)后3月進(jìn)行檢查進(jìn)行OCT以及MP-1微視野計(jì)檢查,觀察患者術(shù)眼FT、黃斑中心10°范圍視網(wǎng)膜MS以及BCVA的變化,分析超聲乳化術(shù)對高度近視患者視網(wǎng)膜厚度及視功能的影響。 結(jié)果：將第一部分患者作為對照組,66例高近合并白內(nèi)障患者OCT檢查手術(shù)前平均FT為211.7±13.9μm,較對照組顯著變薄,P0.05；術(shù)后1月為250.8±31.0μm,術(shù)后3月為229.4±22.6μm,術(shù)后1月平均FT較術(shù)前有顯著性差異,P0.05。MP-1檢測術(shù)前平均MS為6.6±2.5dB,較對照組顯著下降,P0.05；術(shù)后1月為13.4±3.7dB,術(shù)后3月為13.3±3.5dB,均較術(shù)前有顯著提高,P0.05。術(shù)前BCVA≤0.3的患者有64例,術(shù)前平均logMAR BCVA為0.67±0.35,術(shù)后1月時(shí)BCVA在0.4～0.6患者24例,≥0.7的患者41例,術(shù)后1月為0.15±0.20,術(shù)后3月為0.17±0.15,術(shù)后各時(shí)間段較術(shù)前均有顯著性差異P0.05。術(shù)后1月經(jīng)OCT診斷PCME患者有3人。 結(jié)論：高度近視黃斑中心凹厚度較對照組顯著更薄,術(shù)后發(fā)生黃斑厚度增加可能性亦較對照組大,同時(shí)伴視功能下降。
[Abstract]:Part I Changes of macular foveal retinal thickness and retinal sensitivity after phacoemulsification in senile cataract
Objective: To observe the macular fovea thickness and visual function in senile cataract patients after phacoemulsification, and to explore the relationship between macular structure and visual function.
Methods: Optical Coherence Tomography (OCT) combined with microperimetry-1 (MP-1) was used to examine the foveal thickness (FT) of 128 cases of senile cataract before, 1 week, 1 month and 3 months after phacoemulsification. Mean Sensitivity (MS) and Best Corrected Visual Acuity (BCVA) were measured in the 10 degree range of macular center.
Results: The mean FT of 128 patients with simple senile cataract before OCT was 231.7 65507 There were 51 patients with BCVA 0.3 before operation and 77 patients with BCVA 0.4-0.6 before operation. The average LogMAR BCVA was 0.43.22 before operation, 20 patients with BCVA 0.4-0.6 at 1 month after operation, 108 patients with BCVA >0.7 at 1 month after operation. The average LogMAR BCVA was 0.11.13 at 1 month after operation. There was a significant difference compared with that before operation (P 0.05).
Conclusion: Phacoemulsification combined with intraocular lens implantation has little effect on the fundus of senile cataract patients. The postoperative retinal light sensitivity and the best corrected visual acuity are significantly improved.
Part 2 Changes of macular foveal retinal thickness and retinal sensitivity after phacoemulsification in diabetes mellitus with cataract
Objective: To observe the macular fovea thickness and visual function in patients with diabetes mellitus complicated with cataract after phacoemulsification.
Methods: 102 patients with diabetes mellitus complicated with cataract were examined by OCT combined with MP-1 before phacoemulsification, one week, one month and three months after phacoemulsification. The changes of FT, retinal MS and BCVA in the 10.range of macular center were observed, and the effects of phacoemulsification on retinal thickness and visual function were analyzed.
Results: The average FT of the two subgroups was 234.9 65 The mean MS of the two subgroups at 1 week, 1 month and 3 months after surgery was significantly higher than that before surgery (P 0.05). The mean MS of the subgroups above 5 years after surgery was significantly different from that of the control group (P 0.05). Pseudophakic Cystoid Macular Edema (PCME) was found in 5 patients, including 4 patients with a course of more than 5 years.
Conclusion: For diabetic patients with cataract, phacoemulsification is more likely to lead to PCME, and may lead to visual impairment, and patients with longer course of disease affect patients with shorter course of disease is more obvious, postoperative visual function recovery time is longer.
Part 3 Changes of macular foveal retinal thickness and retinal sensitivity after phacoemulsification in high myopia with cataract
Objective: Optical Coherence Tomography (OCT) combined with micro-field MP-1 was used to detect the macular structure and visual function in senile cataract patients, diabetes mellitus and high myopia patients with cataract after phacoemulsification.
Methods: 67 cases of high myopia complicated with cataract were examined by OCT and MP-1 microperimetry before phacoemulsification, one week, one month and three months after phacoemulsification. The changes of FT, retinal MS and BCVA in the 10 degree range of macular center were observed, and the retinal thickness and visual function were analyzed. Influence.
Results: The average FT of 66 patients with high and near cataract was 211.7 B, significantly lower than the control group, P 0.05; 1 month after surgery 13.4 + 3.7 dB, 3 months after surgery 13.3 + 3.5 dB, were significantly higher than preoperative, P 0.05. Preoperative BCVA < 0.3 in 64 patients, preoperative average logMAR BCVA 0.35, 1 month after surgery BCVA 0.4 ~ 0.6 in 24 patients, > 0.7 in 41 patients, 1 month after surgery 0.15 + 0.20, 3 months after surgery 0.17 + 0.15 There was a significant difference between the two groups (P 0.05). Three patients with PCME were diagnosed by OCT one month after operation.
Conclusion: The macular fovea thickness in high myopia is significantly thinner than that in the control group, and the possibility of macular thickness increase after operation is also greater than that in the control group.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R779.66

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