【摘要】： 目的： 1.對比分析IOLMaster和接觸式A超兩種生物測量方法測算伴后鞏膜葡萄腫的高度近視白內障患者IOL度數(shù)的精確性,比較不同IOL計算公式的準確性。 2.對比分析IOLMaster和接觸式A超測得的黃斑水腫患者的眼軸長度(axial length,AL),探討眼軸測量差值與黃斑中心凹厚度的相關性。 3.評價IOLMaster測量硅油眼AL的精確性。 方法： 1.本研究為前瞻性病例對照臨床研究。 2.收集伴后鞏膜葡萄腫的高度近視白內障患者28例(41眼),所有患者均行白內障超聲乳化聯(lián)合IOL植入術,術前分別用IOLMaster和接觸式A超聯(lián)合手動角膜曲率計(manual keratometer,MK)測量生物參數(shù)；并根據(jù)SRK-II,SRK-T,Haigis,Hoffer Q,Holladay 1公式計算IOL度數(shù)；術后3個月檢查患者屈光狀態(tài)。 3.收集確診為黃斑水腫的患者42例(67眼),正常對照組30例(40眼)。應用TOPCON 3D OCT-1000測得病例組及對照組黃斑中心凹厚度,并應用IOLMaster和接觸式A超測量患者的AL。 4.收集在本院行玻璃體切割聯(lián)合硅油填充術的患者26例(30眼),分別于術前1天和術后1個月應用IOLMaster測量AL,觀察前后有無差異。 5.統(tǒng)計學方法：本研究使用SPSS16.0統(tǒng)計學軟件,兩種方法的比較應用配對設計資料的t檢驗、單因素方差分析；不同IOL計算公式間率的比較應用配對設計下兩組頻數(shù)分布χ2檢驗(又稱McNemar檢驗)；應用Pearson相關系數(shù)進行相關性分析。 結果： 1.IOLMaster和接觸式A超測得的AL和前房深度差異均有統(tǒng)計學意義(P=0.005,0.000);IOLMaster與MK測得的角膜曲率差異無統(tǒng)計學意義(P=0.398)。MAE以±1.00D為界做χ2檢驗,只有應用Haigis公式時IOLMaster與接觸式A超差異有統(tǒng)計學意義(χ2=3.953,P=0.047)。應用IOLMaster生物測量方法,SRK/T,Haigis公式最精確,應用接觸式A超聯(lián)合MK生物測量方法Holladay 1,Hoffer Q,Haigis公式最精確,平均絕對屈光誤差(mean absolute refractive error,MAE)較為接近。 2.黃斑水腫患者的平均黃斑中心凹厚度為(377.85±119.84)μm;IOLMaster和接觸式A超測得的AL分別為(22.95±0.97)mm和(22.82±1.04)mm,差異有統(tǒng)計學意義(P=0.003)；但AL差值與OCT測得的黃斑中心凹厚度無相關性(r=-0.097：P=0.447)。 3.應用IOLMaster在有、無硅油填充時測得的AL分別是(24.38±3.18)mm和(24.23±2.91)mm,非參數(shù)檢驗差異無統(tǒng)計學意義(P=0.261)。 結論： 1.對于伴后鞏膜葡萄腫的高度近視白內障患者,只有應用Haigis公式時IOLMaster測算的IOL度數(shù)較接觸式A超精確；應用IOLMaster生物測量方法推薦使用SRK/T,Haigis公式；應用接觸式A超聯(lián)合MK生物測量方法推薦使用Holladay 1,Hoffer Q,Haigis公式。 2.IOLMaster接觸式A超所測得的黃斑水腫患者的AL差異有統(tǒng)計學意義,但是其差值與黃斑中心凹厚度無相關性。 3.有、無硅油填充對IOLMaster測量眼軸沒有影響。
[Abstract]:Objective: 1. To compare and analyze the accuracy of IOLMaster and contact A-ultrasound in estimating the IOL degree of high myopic cataract patients with posterior scleral grape swelling, and to compare the accuracy of different IOL calculation formulas. 2. The eye axis length (axial length,AL) of patients with macular edema measured by IOLMaster and contact A ultrasound was compared and analyzed to explore the correlation between the difference of eye axis and the thickness of macular fovea. 3. To evaluate the accuracy of IOLMaster in measuring AL of silicone eye. Methods: 1. This study is a prospective case-control clinical study. 2. Twenty-eight cases (41 eyes) of high myopia cataract with posterior scleral grape swelling were collected. All patients were treated with phacoemulsification combined with IOL implantation. IOLMaster and contact A ultrasound combined with manual keratometer (manual keratometer, were used before operation. MK) was used to measure biological parameters. The degree of IOL was calculated according to the formula of SRK-II,SRK-T,Haigis,Hoffer QG Holladay 1, and the refractive state of the patients was examined 3 months after operation. 3. 42 cases (67 eyes) of macular edema and 30 cases (40 eyes) of normal control group were collected. The thickness of macular fovea was measured by TOPCON 3D OCT-1000 in case group and control group. IOLMaster and contact A ultrasound were used to measure AL. in patients. 4. A total of 26 patients (30 eyes) who underwent vitrectomy combined with silicone oil implantation in our hospital were collected. IOLMaster was used to measure AL, 1 day before operation and 1 month after operation. 5. Statistical methods: SPSS16.0 software was used to compare the two methods with t-test of paired design data, and single factor analysis of variance (ANOVA). Comparison of the rates of different IOL formulas two groups of frequency distribution 蠂 2 test (also called McNemar test) and Pearson correlation coefficient were used to analyze the correlation between the two groups. Results: there was significant difference between AL and anterior chamber depth measured by 1.IOLMaster and contact A ultrasound (P0. 005U 0. 000). There was no significant difference in corneal curvature between IOLMaster and MK (P < 0. 398). MAE 鹵1. 00D was used as 蠂 2 test). Only when the Haigis formula was used, there was a significant difference between IOLMaster and contact A ultrasound (蠂 2 + 3. 953% P 0. 047). Using IOLMaster biometric method, SRK/T,Haigis formula is the most accurate, and contact A-super combined with MK biometric method Holladay 1Hoffer QI Haigis formula is the most accurate, and the average absolute refractive error (mean absolute refractive error,MAE) is close. 2. The mean foveal thickness of macular fovea in patients with macular edema was (377.85 鹵119.84) 渭 m IOLMaster and (22.95 鹵0.97) mm and (22.82 鹵1.04) mm, respectively (P0. 003). However, there was no correlation between AL difference and macular foveal thickness measured by OCT (r=-0.097:P=0.447). 3. The AL measured by IOLMaster was (24.38 鹵3.18) mm and (24.23 鹵2.91) mm, respectively. Conclusion: 1. For high myopic cataract patients with posterior scleral grape swelling, the IOL degree calculated by IOLMaster with Haigis formula is more accurate than that of contact A, and SRK/T,Haigis formula is recommended by IOLMaster biometrics. In this paper, we recommend the use of Holladay 1 / Hoffer QS Haigis formula by means of contact A ultrasound combined with MK biometrics. There was significant difference in AL between the patients with macular edema measured by 2.IOLMaster contact A ultrasound, but there was no correlation between the difference and the foveal thickness of macular. 3. Yes, no silicone oil filling has no effect on the IOLMaster measurement eye shaft.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R77

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