不同切口矯正白內(nèi)障超聲乳化摘除術(shù)前角膜散光的療效評價
發(fā)布時間：2019-06-08 18:24
【摘要】： 白內(nèi)障是全球主要致盲眼病之一,在我國亦居致盲眼病的首位。迄今為止,手術(shù)是目前唯一有效的治療方法。白內(nèi)障超聲乳化摘除聯(lián)合折疊型人工晶狀體植入術(shù)是當今最主流的手術(shù)方式,具有切口小、手術(shù)時間短及術(shù)后視力恢復好等優(yōu)點。但隨著白內(nèi)障手術(shù)技術(shù)及設(shè)備的提高改進,白內(nèi)障手術(shù)已不僅僅停留在簡單的復明階段,更佳的術(shù)后視覺效果已成為廣大醫(yī)生和患者的追求。研究表明,患者術(shù)前存在的角膜散光及手術(shù)源性散光是影響術(shù)后視力的重要因素。針對這一情況,在行白內(nèi)障超聲乳化摘除手術(shù)時,我們試圖通過采取不同的手術(shù)切口,或同時聯(lián)合不同的角膜散光矯正術(shù),來矯正患者術(shù)前已存在的角膜散光,從而降低或消除術(shù)前角膜散光,力求取得更佳的術(shù)后視功能,最終達到提高患者視覺質(zhì)量的目的。 目的: 對行超聲乳化白內(nèi)障摘除聯(lián)合折疊型人工晶狀體植入術(shù)的患者,根據(jù)術(shù)前角膜地形圖檢查顯示的角膜散光狀態(tài),選擇不同手術(shù)切口,評價其對術(shù)前角膜散光的矯正效果,達到提高視覺質(zhì)量的目的。 方法: 收集2008年9月至2009年8月在我院行白內(nèi)障超聲乳化摘除聯(lián)合折疊型人工晶狀體植入術(shù)的年齡相關(guān)性白內(nèi)障患者63例(77眼),術(shù)前及術(shù)后1周,1月,3月常規(guī)查角膜地形圖,按術(shù)前角膜散光程度分為3組(A組、B組、C組),每組患者選擇不同手術(shù)切口。 A組:17例(22眼):術(shù)前角膜散光≤1.0D,手術(shù)切口為11:00鐘位3.0mm透明角膜切口,3:00鐘位角膜緣內(nèi)做輔助切口。 B組:29例(35眼):術(shù)前角膜散光1.0D～2.0D,分為2組(B1組、B_2組),B_1組:14例(18眼)手術(shù)切口為角膜最陡峭子午線上的透明角膜切口,輔助切口與主切口成120°夾角,B2組:15例(17眼)手術(shù)切口選擇同A組。 C組:17例(20眼):術(shù)前角膜散光2.0D,分2組(C1組、C2組),C1組:9例(10眼)首先完成同A組的手術(shù)操作,術(shù)畢做垂直于角膜最陡峭子午線的成對“T”切口,C2組:8例(10眼)手術(shù)同A組。 術(shù)中均植入Rayner折疊型人工晶狀體。觀察患者術(shù)后1周,1月,3月的裸眼視力、角膜散光、手術(shù)源性角膜散光及散光軸向的變化情況,并進行統(tǒng)計學分析。 結(jié)果: 1、各組術(shù)后裸眼視力情況 各組病例裸眼視力術(shù)后較術(shù)前均有大幅度提高。B1組與B2組裸眼視力比較,術(shù)后1周差別無統(tǒng)計學意義(p0.05),1月、3月差別有統(tǒng)計學意義(p0.01),B1組優(yōu)于B2組;C1組與C2組裸眼視力比較,術(shù)后1周差別無統(tǒng)計學意義(p0.05),1月、3月差別有統(tǒng)計學意義(p0.01),C1組優(yōu)于C2組。 2、各組術(shù)后角膜散光情況 A組角膜散光術(shù)后1周、1月、3月與術(shù)前相比差別均無統(tǒng)計學意義(p0.05)。B1組患者的角膜散光術(shù)后1周、1月、3月較術(shù)前均減小,與術(shù)前比較差別有統(tǒng)計學意義(p0.05, p0.01, p0.01),B1組與B2組平均角膜散光3個時間點比較,術(shù)后1周差別無統(tǒng)計學意義(p0.05),術(shù)后1月、3月差別有統(tǒng)計學意義(p0.01),B1組角膜散光低于B2組。C1組患者的角膜散光術(shù)后1周、1月、3月較術(shù)前均減小,與術(shù)前比較差別有統(tǒng)計學意義(p0.01),術(shù)后1周、1月、3月C1組與C2組平均角膜散光比較,差別有統(tǒng)計學意義(p0.05, p0.01, p0.01),C1組角膜散光低于C2組。 3、各組術(shù)后手術(shù)源性散光的大小 各組術(shù)式均產(chǎn)生一定的手術(shù)源性散光,隨時間推移手術(shù)源性散光逐漸減小,各組手術(shù)源性散光術(shù)后1周與1月比較,1月與3月比較差別均無統(tǒng)計學意義(p0.05)。B1組與B2組各時間點手術(shù)源性散光比較差別均無統(tǒng)計學意義(p0.05),C1組與C2組各時間點手術(shù)源性散光比較差別均無統(tǒng)計學意義(p0.05)。 4、各組術(shù)后散光軸向的改變 各組角膜散光軸術(shù)后1周向順規(guī)散光改變,術(shù)后1月逐漸向逆規(guī)散光改變,但構(gòu)成比比較,各組術(shù)后1周與1月,1月與3月差別均無統(tǒng)計學意義(p0.05)。B1組與B2組各時間點散光軸向構(gòu)成比比較,差別無統(tǒng)計學意義(p0.05),C1組與C2組各時間點散光軸向構(gòu)成比比較,差別無統(tǒng)計學意義(p0.05)。 結(jié)論: 1、術(shù)前角膜散光1D的白內(nèi)障患者,行3mm透明角膜切口超聲乳化術(shù),角膜散光度數(shù)無明顯變化。 2、術(shù)前角膜散光1.0D～2.0D的白內(nèi)障患者,選擇位于角膜最陡峭子午線上的透明角膜切口可以部分矯正術(shù)前散光。 3、術(shù)前角膜散光2.0D的白內(nèi)障患者做垂直于角膜最陡峭子午線的成對“T”切口,能有效地矯正術(shù)前角膜散光。
[Abstract]:Cataract is one of the main causes of blindness in the world. So far, surgery is the only effective way to treat. Cataract phacoemulsification and foldable intraocular lens implantation is the most mainstream operation in the present day. It has the advantages of small incision, short operation time and good recovery of vision after operation. However, with the improvement of the technique of cataract surgery and the improvement of the equipment, the cataract surgery has not only stayed in a simple reming stage, and the better postoperative visual effect has become the pursuit of a large number of doctors and patients. The study shows that the pre-operative corneal astigmatism and surgical-derived astigmatism are important factors that affect the postoperative visual acuity. In response to this, we have attempted to correct pre-operative corneal astigmatism by taking different surgical incisions or, at the same time, in combination with different corneal astigmatism, to reduce or eliminate pre-operative corneal astigmatism, And the aim of improving the visual quality of the patient is finally achieved. Objective: To study the corneal astigmatism status of patients with cataract extraction combined with foldable intraocular lens implantation, and to select different surgical incisions according to the pre-operative corneal topography. the correction effect of the astigmatism is improved, visual quality Methods:63 cases (77 eyes) of age-related cataract with cataract phacoemulsification and foldable intraocular lens implantation in our hospital from September 2008 to August 2009 were collected. In the week, January and March, the corneal topography was examined and divided into 3 groups (group A, group B, C) according to the degree of astigmatism before operation. Group), different operative incisions were selected for each group. Group A:17 (22 eyes): pre-operative corneal astigmatism, 1.0 D, surgical incision of 11:00, and a clear angle of 3.0 mm Incision of the membrane,3:00, the secondary incision in the limbal. Group B:29 (35 eyes): the pre-operative corneal astigmatism was 1.0D-2.0D, divided into two groups (group B1, group B _ 2), and group B _ 1:14 (18-eye) surgical incision was the most steep meridian of the cornea. Clear corneal incision, the auxiliary incision is 120 擄 with the main incision Angle, B2 group:15 (17 eyes) surgical incision and group A. Group C:17 (20 eyes): pre-operative corneal astigmatism of 2.0D, partial group 2 (C1 group, C2 group), C1 group:9 (10 eyes) first completed the operation of the same group, and it was made to be perpendicular to the most steep meridian of the cornea. T " cut, C2 group:8 (10 The patients with the same group A were implanted with the Rayner's foldable intraocular lens. The visual acuity and the angle of the naked eyes at 1 week, January and March after the operation were observed. membrane astigmatism , surgical-derived corneal astigmatism and astigmatism Axial change and statistical analysis. Results:1. There was a significant increase in the visual acuity of the naked eyes in each group after the operation. The visual acuity of the naked eyes in the group B1 and the group B2 was not statistically significant (p0.05), the difference of the 1-month and the third month was statistically significant (p0.01), the B1 group was better than that of the B2 group, and the visual acuity of the naked eyes in the C1 group and the C2 group. Comparison,1-week difference after surgery No statistical significance (p0.05) There was no significant difference (p0.01) in the first month and the third month, and the C1 group was superior to that of the C2 group. The average corneal astigmatism in the B1 group and the B2 group was compared with the average corneal astigmatism for 1 week, the first week, the first month and the third month after the astigmatism, and the average corneal astigmatism in the B1 group and the B2 group was compared with the mean corneal astigmatism for 1 week. The difference was not significant (p0.05), the difference was statistically significant (p0.01) in the first month and the third month after the operation, and the corneal astigmatism in the B1 group was lower than that of the B2 group. In the C1 group, the corneal astigmatism was decreased 1 week,1 month and 3 months after the operation, and the difference was statistically significant (p0.01),1 week,1 month,3 months, and C. The comparison of average corneal astigmatism in group 2 and the difference between the two groups The mean corneal astigmatism in the C1 group was lower than that of the first group (p0.05, p0.01, p0.01). In group C2.3, the operation-induced astigmatism in each group had a certain operation-induced astigmatism, and the operation-induced astigmatism gradually decreased over time, and the operation-induced astigmatism was compared with one month after operation. There was no significant difference between January and March (p0.05). There is no statistical difference in the comparative difference of the operation-derived astigmatism. The difference of operation-derived astigmatism for each time point in group C1 and C2 was of no statistical significance (p0.05). P 0.05).4. The postoperative astigmatism in each group was changed by one week after the operation of the corneal astigmatism axis, and the incidence of astigmatism was gradually changed to the normal astigmatism in the first month after the operation, but there was no significant difference between 1 week and January, January and March after the operation (p0.05). The B1 and B2 groups At each time of the group The axial composition ratio of the point-to-point astigmatism was not statistically significant (p0.05), and the astigmatism axial composition of the time points in the C1 and C2 groups was not statistically significant (p0.05). The difference was not significant (p0.05). Conclusion:1. The cataract with 1 D of the pre-operative corneal astigmatism is a 3-mm clear angle. There was no apparent change in the degree of corneal astigmatism. The corneal astigmatism was 1.0D ~ 2.0D in the patients with cataract, and the choice of corneal astigmatism was on the most steep meridian of the cornea.
【學位授予單位】：承德醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R779.66
本文編號：2495481
[Abstract]:Cataract is one of the main causes of blindness in the world. So far, surgery is the only effective way to treat. Cataract phacoemulsification and foldable intraocular lens implantation is the most mainstream operation in the present day. It has the advantages of small incision, short operation time and good recovery of vision after operation. However, with the improvement of the technique of cataract surgery and the improvement of the equipment, the cataract surgery has not only stayed in a simple reming stage, and the better postoperative visual effect has become the pursuit of a large number of doctors and patients. The study shows that the pre-operative corneal astigmatism and surgical-derived astigmatism are important factors that affect the postoperative visual acuity. In response to this, we have attempted to correct pre-operative corneal astigmatism by taking different surgical incisions or, at the same time, in combination with different corneal astigmatism, to reduce or eliminate pre-operative corneal astigmatism, And the aim of improving the visual quality of the patient is finally achieved. Objective: To study the corneal astigmatism status of patients with cataract extraction combined with foldable intraocular lens implantation, and to select different surgical incisions according to the pre-operative corneal topography. the correction effect of the astigmatism is improved, visual quality Methods:63 cases (77 eyes) of age-related cataract with cataract phacoemulsification and foldable intraocular lens implantation in our hospital from September 2008 to August 2009 were collected. In the week, January and March, the corneal topography was examined and divided into 3 groups (group A, group B, C) according to the degree of astigmatism before operation. Group), different operative incisions were selected for each group. Group A:17 (22 eyes): pre-operative corneal astigmatism, 1.0 D, surgical incision of 11:00, and a clear angle of 3.0 mm Incision of the membrane,3:00, the secondary incision in the limbal. Group B:29 (35 eyes): the pre-operative corneal astigmatism was 1.0D-2.0D, divided into two groups (group B1, group B _ 2), and group B _ 1:14 (18-eye) surgical incision was the most steep meridian of the cornea. Clear corneal incision, the auxiliary incision is 120 擄 with the main incision Angle, B2 group:15 (17 eyes) surgical incision and group A. Group C:17 (20 eyes): pre-operative corneal astigmatism of 2.0D, partial group 2 (C1 group, C2 group), C1 group:9 (10 eyes) first completed the operation of the same group, and it was made to be perpendicular to the most steep meridian of the cornea. T " cut, C2 group:8 (10 The patients with the same group A were implanted with the Rayner's foldable intraocular lens. The visual acuity and the angle of the naked eyes at 1 week, January and March after the operation were observed. membrane astigmatism , surgical-derived corneal astigmatism and astigmatism Axial change and statistical analysis. Results:1. There was a significant increase in the visual acuity of the naked eyes in each group after the operation. The visual acuity of the naked eyes in the group B1 and the group B2 was not statistically significant (p0.05), the difference of the 1-month and the third month was statistically significant (p0.01), the B1 group was better than that of the B2 group, and the visual acuity of the naked eyes in the C1 group and the C2 group. Comparison,1-week difference after surgery No statistical significance (p0.05) There was no significant difference (p0.01) in the first month and the third month, and the C1 group was superior to that of the C2 group. The average corneal astigmatism in the B1 group and the B2 group was compared with the average corneal astigmatism for 1 week, the first week, the first month and the third month after the astigmatism, and the average corneal astigmatism in the B1 group and the B2 group was compared with the mean corneal astigmatism for 1 week. The difference was not significant (p0.05), the difference was statistically significant (p0.01) in the first month and the third month after the operation, and the corneal astigmatism in the B1 group was lower than that of the B2 group. In the C1 group, the corneal astigmatism was decreased 1 week,1 month and 3 months after the operation, and the difference was statistically significant (p0.01),1 week,1 month,3 months, and C. The comparison of average corneal astigmatism in group 2 and the difference between the two groups The mean corneal astigmatism in the C1 group was lower than that of the first group (p0.05, p0.01, p0.01). In group C2.3, the operation-induced astigmatism in each group had a certain operation-induced astigmatism, and the operation-induced astigmatism gradually decreased over time, and the operation-induced astigmatism was compared with one month after operation. There was no significant difference between January and March (p0.05). There is no statistical difference in the comparative difference of the operation-derived astigmatism. The difference of operation-derived astigmatism for each time point in group C1 and C2 was of no statistical significance (p0.05). P 0.05).4. The postoperative astigmatism in each group was changed by one week after the operation of the corneal astigmatism axis, and the incidence of astigmatism was gradually changed to the normal astigmatism in the first month after the operation, but there was no significant difference between 1 week and January, January and March after the operation (p0.05). The B1 and B2 groups At each time of the group The axial composition ratio of the point-to-point astigmatism was not statistically significant (p0.05), and the astigmatism axial composition of the time points in the C1 and C2 groups was not statistically significant (p0.05). The difference was not significant (p0.05). Conclusion:1. The cataract with 1 D of the pre-operative corneal astigmatism is a 3-mm clear angle. There was no apparent change in the degree of corneal astigmatism. The corneal astigmatism was 1.0D ~ 2.0D in the patients with cataract, and the choice of corneal astigmatism was on the most steep meridian of the cornea.
【學位授予單位】：承德醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R779.66
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