【作者】 张莹；

【导师】 梁皓；

【作者基本信息】 广西医科大学 ， 眼科学（专业学位）， 2015， 硕士

【摘要】 目的：本研究通过对虹膜固定型人工晶状体(Verisyse iris-fixated phakic intraocular lens, Verisyse PIOL)植入术后(6-10年)平均8年与术后平均4.5年的患者视觉质量临床指标进行观察对比,对PIOL植入术后远期有效性、安全性做出评价。方法：回顾性分析自2005年开展Verisyse PIOL植入术后持续追踪随访的12例患者(6-10年)平均8年的裸眼视力Uncorrected Visual Acuity UCVA)、最佳矫正视力(Best Spectacle-Corrected Visual Acuity BSCVA)、散光度、非接触眼压、前房深度、角膜内皮细胞密度(Endothelial celldensity, ECD)、PIOL在前房的位置、瞳孔形态、虹膜变化、晶状体的变化、眼底情况与手术前、术后1个月、术后4.5年同组数据进行比较。结果：术后8年随访患者中,58.3%(14眼)UCVA≥0.5,33.3%(8眼)UCVA≥0.8。BSCVA≥0.5占100%(24眼),BSCVA≥0.8占70.8%(17眼)。UCVA术后8年与术后4.5年相比配对t检验差异无统计学意义(t=1.342,p>0.05),与术后1个月相比较差异无统计学意义(t=1.595,p>0.05),与术前相比较差异有统计学意义(t=8.846, p<0.01)。BSCVA术后8年与术后4.5年相比配对t检验差异无统计学意义(t=0.620,p>0.05),与术后1个月相比较差异无统计学意义(t=0.490,P>0.05),与术前相比较差异均有统计学意义(t=2.434,P<0.05)。裸眼视力、矫正视力随着时间延长变化趋势,UCVA在术后1个月、术后4.5年、术后8年相比较无统计学意义(F=1.138, P>0.05), BSCVA在术后1个月、术后4.5年、术后8年相比较无统计学意义(F=1.277,P>0.05)。在散光度方面,术后8年与术前相比(t=1.621,p>0.05)差异无统计学意义,与术后1个月相比(t=1.946,p>0.05)差异无统计学意义、与术后4.5年相比(t=1.474,p>0.05)差异无统计学意义,随着时间延长散光度无明显变化。术后8年1眼眼压为22mmHg,余均在正常范围内,术后8年与术前、术后1个月、术后4.5年相比较,差异无统计学意义。术后8年前房深度比术后4.5年变浅,p<0.01差异有统计学意义,与术前相比前房深度变浅,p<0.01差异有统计学意义。角膜内皮细胞数术后8年与术后4.5年比较差异有统计学意义(P<0.01),术后8年角膜内皮细胞数比术后4.5年有所下降。24眼中3(12.5%)眼发生PIOL不全脱位,其中1(4.2%)眼是因为拳头打伤颞侧晶状体袢脱落,1(4.2%)眼因撞击后出现鼻侧晶状体袢脱落,1眼(4.2%)是搬动重物期间一侧晶状体袢脱落,3(12.5%)眼发生PIOL下移,下移程度>0.5mm,其中晶状体袢单侧下移为2(8.3%)眼,双侧下移为1(4.2%)眼。结论：Verisyse PIOL植入术后远期随访显示裸眼视力、最佳矫正视力保持稳定,散光度、眼压无明显变化,前房深度变浅,部分患者出现了角膜内皮细胞数下降、人工晶状体脱位及移位相应并发症,但由于本研究例数较少,对于远期安全性有待进一步观察和研究。更多还原

【Abstract】 Objective:This study of Verisyse PIOL implantation (6-10 years) with an average of 8 years The average postoperative visual quality of clinical param-eters were observed 4.5 years compared PIOL implantation for longterm effic-acy and safety assessed.Methods:A retrospective analysis conducted since 2005 Verisyse PIOL implantation keep track of follow-up,12 patients (6-10 years) an average of 8 years of uncorrected visual acuity (Uncorrected Visual Acuity UCVA), best corrected visual acuity (Best Spectacle-Corrected Visual Acuity BSCVA), astigmatism, non-contact intraocular pressure, changes in anterior chamber depth, corneal endothelial cell density (Endothelial cell density, ECD), PIOL position of the anterior chamber, pupil shape, change the iris, lens and fundus and surgery before, after a month, after 4.5 years of data were compared with the group.Results:After eight years of follow-up of patients,58.3%(14eye) UCVA≥ 0.5,33.3%(8 eye) UCVA≥0.8. BSCVA≥0.5100%(24eye), BSCVA≥0.8 acco-unted for 70.8%(17eye). UCVA after 8 years and 4.5 years after surgery comp-ared to paired t-test showed no significant difference (t=1.342, p> 0.05), comp-ared with after a month difference was not statistically significant (t=1.595, p >0.05), compared with the preoperative difference was statistically significant (t =8.846, p<0.01). BSCVA after 8 years and 4.5 years after surgery compared to paired t-test showed no significant difference (t=0.620, p>0.05), compared with after a month difference was not statistically significant (t=0.490, P> 0.05), compared with the preoperative differences were statistically significant (t= 2.434, P<0.05); uncorrected visual acuity, corrected visual acuity with time trends, UCVA after surgery a month, after 4.5 years, patients After eight years with no statistically significance (F=1.138, P>0.05), BSCVA in after a month, after 4.5 years, after eight years with no statistical significance (F=1.277, P> 0.05). In astigmatism, compared with preoperative (t=1.621, p>0.05) difference was not statistically significant after 8 years, compared to a month after (t= 1.946, p>0.05) was not statistically significance, compared with 4.5 years after surgery (t=1.474, p>0.05) difference was not statistically significant. As time no significant change in the degree of astigmatism. After eight years of an IOP of 22mmHg, others in the normal range. After 8 years with preoperative and postoperative 1 month, compared with 4.5 years postoperatively, the difference was not statistically significant. After 8 years ago chamber depth shallower than that after 4.5 years, p<0.01 was statistically significant. Compared with the preoperative anterior chamber depth shallow, p<0.01 was statistically significant. Number of corneal endothelial cells after 8 years and 4.5 years difference was statistically significant (P<0.01), after 8 years of corneal endothelial cell counts down from 4.5 years after surgery.3 eyes (12.5%) in the 24 eyes PIOL subluxation occurs,1 (4.2%) eye because the temporal side of the lens fist wounded loop off.1 (4.2%) eye after a collision occurs because the eye lens loop nasal shedding,1 (4.2%) eye is the side of the lens moving heavy objects during the loop off,3 (12.5%) eyes occurred PIOL down, down the extent of> 0.5 mm. Down one side of which the lens loop 2 (8.3%) eyes, bilateral down to 1 (4.2%) eye.Conclusion:Verisyse PIOL implantation of long-term postoperative follow-up showed uncorrected visual acuity, best corrected visual acuity remained stable, no significant changes in intraocular pressure and astigmatism, shallow anterior chamber depth, some patients had corneal endothelial cells decreased intraocular lens dislocation and displacement corresponding complications, but due to less number of cases in this study, for the long-term safety needs further study and research.更多还原