【摘要】： 目的 后發(fā)性白內(nèi)障(after cataract, AC),又稱為后囊膜混濁(posterior capsule opacification, PCO),是白內(nèi)障囊外摘除術(shù)伴或不伴人工晶體植入術(shù)后常見的也是當(dāng)今世界范圍內(nèi)熱點(diǎn)研究的并發(fā)癥,術(shù)后殘留的晶狀體上皮細(xì)胞(lens epithelialcells,LECs)的移行和增殖是其發(fā)生的中心環(huán)節(jié)和細(xì)胞學(xué)基礎(chǔ)。長期以來,眼科工作者一直在尋求能應(yīng)用于眼內(nèi)的清除或抑制晶狀體上皮細(xì)胞的藥物來預(yù)防白內(nèi)障術(shù)后囊膜混濁這一常見并發(fā)癥。本研究探討白內(nèi)障超聲乳化術(shù)中水分離時應(yīng)用無防腐劑的1%利多卡因?qū)蟀l(fā)性白內(nèi)障形成的影響,為尋求白內(nèi)障術(shù)中清除晶狀體上皮細(xì)胞,預(yù)防囊膜混濁提供有效藥物的實(shí)驗依據(jù)。 方法 收集2009年3月至2009年10月期間于鄭州大學(xué)第二附屬醫(yī)院眼科治療的年齡相關(guān)性白內(nèi)障患者65例72只眼,隨機(jī)分為對照組即A組,水分離時使用平衡鹽溶液(balanced salt solution, BSS)和用藥組即B組,水分離時使用無防腐劑的1%利多卡因,其年齡分布42～85歲,平均68.58±13.32歲。在白內(nèi)障超聲乳化術(shù)中,使用無防腐劑的1%利多卡因在晶狀體囊袋內(nèi)進(jìn)行水分離,使其直接快速作用于晶狀體上皮細(xì)胞。于白內(nèi)障超聲乳化吸出術(shù)聯(lián)合人工晶體植入手術(shù)術(shù)前1天、術(shù)后第1天、術(shù)后第3天測量術(shù)眼眼壓情況,術(shù)前1天、術(shù)后3天檢測術(shù)眼角膜內(nèi)皮情況,術(shù)后第1天、第3天、第7天、第14天和術(shù)后第1月、第3月、第6月在裂隙燈顯微鏡下檢查手術(shù)眼的切口愈合程度、角膜恢復(fù)情況以及前房是否有炎癥反應(yīng)等,術(shù)后第1月、術(shù)后第6月檢查其最佳矯正遠(yuǎn)視力,并且于術(shù)后第1月、第3月、第6月在裂隙燈顯微鏡下觀察后囊膜混濁情況,通過比對后囊膜混濁的標(biāo)準(zhǔn),進(jìn)行對后囊膜混濁程度的評分,比較各組晶狀體后囊混濁情況。采用SPSS13.0統(tǒng)計軟件進(jìn)行統(tǒng)計處理。 結(jié)果 1.術(shù)后角膜情況 術(shù)后3天幾乎所有術(shù)眼切口周圍角膜均有水腫,多為輕度水腫,但均在1周內(nèi)消失,從發(fā)生角膜水腫眼數(shù)的情況比較,兩組間差異無統(tǒng)計學(xué)意義(χ2=0.215,P0.05)。從角膜水腫程度來看,術(shù)后第7天,兩組間差異無統(tǒng)計學(xué)意義(Z=-0.486,P0.05)。 2.術(shù)后前房情況 術(shù)后第1天和第3天兩組部分術(shù)眼出現(xiàn)前房反應(yīng),從發(fā)生前房反應(yīng)眼數(shù)的情況比較,兩組間差異無統(tǒng)計學(xué)意義(χ2=0.400,P0.05)。術(shù)后第7天觀察兩組前房反應(yīng)情況,A組只有1例出現(xiàn)前房反應(yīng)。從房水混濁程度對情況進(jìn)行比較,術(shù)后第7天,兩組間差異無統(tǒng)計學(xué)意義(Z=-1.000,P0.05)。 3.術(shù)眼眼壓情況 術(shù)前1天,A、B兩組間眼壓比較結(jié)果,差異無統(tǒng)計學(xué)意義(t=0.120,P0.05),術(shù)后第1天,A、B兩組間眼壓比較結(jié)果,差異無統(tǒng)計學(xué)意義(t=0.812,P0.05),術(shù)后第3天,A、B兩組間眼壓比較結(jié)果,差異無統(tǒng)計學(xué)意義(t=-0.981,P0.05)。 A組術(shù)前1天和術(shù)后第1天相比較,差異有統(tǒng)計學(xué)意義(t=-20.018,P0.05),術(shù)前第1天和術(shù)后第3天相比較,差異無統(tǒng)計學(xué)意義(t=0.117,P0.05),術(shù)后第1天和術(shù)后第3天相比較,差異有統(tǒng)計學(xué)意義(t=20.273,P0.05)。B組術(shù)前第1天和術(shù)后第1天相比較,差異有統(tǒng)計學(xué)意義(t=-20.673,P0.05),術(shù)前第1天和術(shù)后第3天相比較,差異無統(tǒng)計學(xué)意義(t=0.887,P0.05),術(shù)后第1天和術(shù)后第3天相比較,差異有統(tǒng)計學(xué)(t=19.900,P0.05)。 4.術(shù)后最佳矯正遠(yuǎn)視力 術(shù)后第1個月,A組與B組的最佳矯正遠(yuǎn)視力比較,差異無統(tǒng)計學(xué)意義(t=-0.645,P0.05)。術(shù)后第6個月,A組與B組的最佳矯正遠(yuǎn)視力比較,差異有統(tǒng)計學(xué)意義(t=-2.763，P0.05)。 5.術(shù)眼角膜內(nèi)皮情況 術(shù)前1天,A組與B組術(shù)眼角膜內(nèi)皮密度比較,差異無統(tǒng)計學(xué)意義(t=-1.163,P0.05)。術(shù)后3天,A組與B組術(shù)眼角膜內(nèi)皮密度比較,差異無統(tǒng)計學(xué)意義(t=1.326，，P0.05)。6.術(shù)后后囊混濁情況 術(shù)后1個月,A組有2只眼出現(xiàn)后囊膜混濁,B組有1只出現(xiàn)后囊膜混濁,兩組比較,差異無統(tǒng)計學(xué)意義(χ2=0.348,P0.05)。術(shù)后3個月,A組有5只眼出現(xiàn)后囊膜混濁,B組有2只出現(xiàn)后囊膜混濁,兩組比較,差異無統(tǒng)計學(xué)意義(χ2=1.424,P0.05)。術(shù)后6個月,A組有18只眼出現(xiàn)后囊膜混濁,B組有3只出現(xiàn)后囊膜混濁,兩組比較,差異有統(tǒng)計學(xué)意義(χ2=15.126,P0.05)。 術(shù)后1個月,A組與B組的后囊膜混濁分值比較,差異無統(tǒng)計學(xué)意義(Z=-0.602,P0.05)。術(shù)后3個月,A組與B組的后囊膜混濁分值比較,差異無統(tǒng)計學(xué)意義(Z=-1.151,P0.05)。術(shù)后6個月,A組與B組的后囊膜混濁分值比較,差異有統(tǒng)計學(xué)意義(Z=-3.885,P0.05)。 結(jié)論 本研究表明,在白內(nèi)障超聲乳化術(shù)中水分離時,于晶狀體囊袋內(nèi)注射無防腐劑的1%利多卡因,能夠在破壞晶狀體上皮細(xì)胞的同時,不會損傷眼內(nèi)其他組織,從而較安全有效的抑制后發(fā)性白內(nèi)障的形成,并可能成為一種更快捷、方便、可靠的防治后發(fā)障的臨床應(yīng)用方案。
[Abstract]:Purpose Posterior capsular opacification (PCO), also known as posterior capsule opacification (PCO), is common to extracapsular cataract extraction with or without intraocular lens implantation. The migration and proliferation of the residual lens epithelial cells (LECs) after operation are the central link and the cell in which the complications occur. For a long time, ophthalmologists have long been looking for drugs that can be applied to the removal or suppression of lens epithelial cells in the eye, which is common in the prevention of capsular opacification after cataract surgery. The effect of 1% lidocaine without preservative on the formation of posterior cataract was discussed in this study. The effect of 1% lidocaine without preservative on the formation of posterior cataract was discussed, and the effective drug was provided for the prevention of lens epithelial cells and the prevention of capsular opacification. Yi Yi Methods From March 2009 to October 2009,65 cases of age-related cataract in the second affiliated hospital of Zhengzhou University were collected, and 65 cases were randomly divided into control group, group A, and balanced salt solution was used for water separation. BSS and group B,1% lidocaine without preservative was used at the time of water separation, and the age distribution was 42-85 years. 8.58 to 13.32 years of age. In phacoemulsification, a 1% lidocaine without a preservative was used to separate the water in the lens pocket, making it very fast Intraocular pressure was measured on the lens epithelial cells at a rate of 1 day before operation,1 day after operation,1 day after operation,1 day after operation,1 day after operation,3 days after operation, and 7 days after operation. On day 14 and in the first and third months of the operation, the degree of incision healing, the recovery of the cornea and the presence of an inflammatory reaction in the anterior chamber were examined under a slit-lamp microscope in the first month of the operation. and the posterior capsule opacification was observed under the slit lamp microscope in the first month, the third month and the sixth month after the operation, and the degree of the posterior capsule opacification was scored, compared, The posterior capsule of each group was turbid. SPSS13 was used. 0 series Statistical Office of the meter software Results 1. There were edema of the cornea in the surrounding cornea after operation for 3 days after the operation of the cornea, most of which were mild edema, but all disappeared within 1 week, and the difference between the two groups was compared with the case of the number of the corneal edema. There was no statistical significance (Sup2 = 0.215, P0.05). From the degree of corneal edema, the difference between the two groups was 7 days after operation. no statistical significance ( Z =-0.486, P <0.05).2. The anterior chamber response was observed in the first and third days after the operation of the anterior chamber. In comparison, there was no statistical difference between the two groups (Sup2 = 0.400, P0.001). 5) The anterior chamber response of the two groups was observed on the 7th day after the operation. On Day 7, the difference between the two groups There was no statistical significance (Z =-1.000, P0.05).3. The results of the intraocular pressure in the group A and B were not statistically significant (t = 0.120, P0.05). The results of the comparison of intraocular pressure showed no significant difference (t = 0.812, P0.05). The results showed no significant difference (t =-20.018, P0.05). The difference was not significant (t =-20.018, P0.05), and the difference was not significant (t = 0.117, P0. The difference was statistically significant (t =-20.73, P0.05), the difference was not significant (t =-20.673, P0.05), and the difference was not statistically significant (t = 0.887, P, P <0.05). 0.05), post-op day 1 Compared with the 3rd day after operation, the difference was statistically significant (t = 19.900, P0.05). In the first month of the operation, the best corrected distance between group A and group B was no significant difference (t =-0.645, P0. 05).6-month post-operation The difference between group A and group B was statistically significant (t =-2.763, P0.05). 5. There was no significant difference in the density of the corneal endothelium in group A and group B before operation (t =-). 1.163,P0 (.05). There was no significant difference between group A and group B (t = 1.326, P0.05).6. The posterior capsule opacification in group A and group B was not significant (t = 1.326, P0.05). One month after the operation, there were 2 eyes in group A and 2 eyes in group A, and 1 in group B was turbid. There was no statistical difference between the two groups (Sup2 = 0.348, P0.05). There were 2 cases of posterior capsule opacification in group A and 2 in group B after operation. There was no significant difference between the two groups (Sup2 = 1.424, P0.05). The posterior capsule opacification was found in 18 eyes in group A and the posterior capsule opacification in group B after 6 months, and there were 3 cases of posterior capsule opacification in group B. (2 = 15.126, P0.05). The posterior capsule opacification score of group A and group B was less than that of group B after operation for 1 month. The statistical significance (Z =-0.602, P0.05). The posterior capsule opacification score of group A and group B was less than that of group B after 3 months. Ji Xue Significance (Z =-1.151, P0.05). After 6 months of operation, the haze scores of the posterior capsule of group A and group B were statistically significant (Z =-3.885, P0.05). Conclusion This study shows that 1% lidocaine without preservative can be injected into the capsular bag when the water is separated in the phacoemulsification.
【學(xué)位授予單位】：鄭州大學(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(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 董偉華;兩種不同類型人工晶狀體植入術(shù)后前房深度和屈光度變化的臨床研究[D];鄭州大學(xué);2013年

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