摘要
背景后发性白内障的发生使1CU可调节人工晶状体（1CUAIOL）的拟调节力及远近视功能明显下降，影响其远期临床效果。目前国内外关于后发性白内障对IOL眼内移动度的影响及Nd：YAG激光后囊膜切开术后是否可恢复IOL眼内移动度的研究报道较少。目的探讨后发性白内障及Nd：YAG激光后囊膜切开术对1CUAIOL眼内移动度的影响。方法采用系列病例观察试验设计。收集因单纯性白内障行白内障超声乳化摘出术联合1CUAIOL植入术后发生后发性白内障者20例24眼，分别于IOL植入术后3个月、Nd：YAG激光后囊膜切开术前1d、Nd：YAG激光后囊膜切开术后3个月进行随访观察，检测术眼最佳矫正远视力下的近视力（DCNVA），并用IOLMaster检测10g／L匹罗卡品滴眼液点眼前及点眼后的前房深度，计算其差值作为IOL的眼内移动度。比较上述3个时间点IOL的眼内移动度变化，评价后发性白内障及激光治疗对1CUAIOL眼内移动的影响。结果1CUAIOL植入术后3个月IOL的眼内移动度为（0．44±O．21）mm，发生后发性白内障后，术眼行Nd：YAG激光后囊膜切开术前1dIOL的眼内移动度为（0．27±0．11）mm，Nd：YAG激光后囊膜切开术后3个月IOL的眼内移动度为（0．34±0．10）mm，3个时间点间IOL的眼内移动度差异有统计学意义（F=7．180，P=0．001），与IOL植入术后3个月比较，Nd：YAG激光后囊膜切开术前1dIOL的眼内移动度明显下降，差异有统计学意义（P=0．006）；与后囊膜切开术前1d相比，Nd：YAG激光后囊膜切开术后3个月IOL的眼内移动度略有增加，但差异无统计学意义（P=0．059）。1CUAIOL植入术后3个月术眼DCNVA为（3．1±O．9）J，Nd：YAG激光后囊膜切开术前1d为（6．2±0．8）J，Nd：YAG激光后囊膜切开术后3个月为（3．4±O．7）J，3个时间点间的差异有统计学意义（F=110。270，P=0．000），其中Nd：YAG激光后囊膜切开术前1d术眼DCNVA明显低于IOL植入术后3个月，差异有统计学意义（P〈0．05），与后囊膜切开术前1d相比，Nd：YAG激光后囊膜切开术后3个月术眼DCNVA明显增加，差异有统计学意义（P〈0．05）。IOL植入术后3个月、Nd：YAG激光后囊膜切开术前1d、Nd：YAG激光后囊膜切开术后3个月DCNVA与1CUAIOL的眼内移动度均无显著的相关性（r，=-0．150，P1=0．486；r2=-0．320，P：=0．122：r3=-0．100，P3=0．633）。结论后发性白内障使1CUAIOL的眼内移动度明显下降，Nd：YAG激光后囊膜切开术对IOL的移动度并无明显影响，但术后术眼仍可恢复较好的视近功能，可能与多种因素产生的拟调节有关。
Background Posterior capsular opacification （PCO）affects the pseudoaccommodation of l CU accommodative intraocular lens （ 1CU AIOL）. At present, few studies on the effect of PCO and Nd： YAG laser capsulotomy on intraocular shifting of 1CU AIOL are published. Objective The present study was to evaluate the effect of PCO and Nd：YAG laser capsulotomy on the shifting of 1CU AIOL. Methods A respective serial case- observational study was designed. Written informed consent was obtained from each patient prior to this study. Twenty- four eyes of 20 patients with PCO after phacoemulsification and implantation of 1CU AIOL were included in this study. Ocular examination was performed 3 months after IOL implantation, 1 day before Nd： YAG laser capsulotomy and 3 months after Nd： YAG laser eapsulotomy to evaluate the distance corrected near visual acuity （ DCNVA）. The difference in the anterior chamber depths before and after administering 1% pilocarpine topical eye drops wasmeasured with the IOLMaster to determine the intraocular shifts of the IOL. The extent of IOL shifting was compared among 3 time points to assess the factors influencing IOL accommodation after 1CU AIOL implantation. Results The shifting amplitude of 1CU AIOL was （0.44±0. 21 ） mm 3 months after implantation of 1CU AIOL, （0.27±0. 11 ） mm 1 day before Nd ： YAG laser capsulotomy, and（0.34±0. 10） mm 3 months after Nd ： YAG laser capsulotomy, showing a significant difference among them（ F= 7. 180, P = 0. 001 ）. The shifting amplitude of 1 CU AIOL significantly declined 1 day before Nd：YAG laser capsulotomy in comparison with 3 months after implantation of 1CU AIOL（P = 0. 006）. The shifting amplitude 3 months after Nd：YAG laser capsulotomy increased slightly in comparison with 1 day before Nd：YAG laser capsulotomy（P= 0. 059）. DCNVA was（3. 1±0. 9）J 3 months after implantation of 1CU AIOL, （6.2± 0.8） J 1 day before Nd ： YAG laser capsulotomy and （ 3.4 ±0.7 ） J 3 months after Nd ： YAG laser capsulotomy, with a significant difference among them （ F = 110. 270, P = 0. 000 ）. DCNVA was lower 1 day before Nd： YAG laser capsulotomy than 3 months after implantation of 1CU AIOL（ P〈0.05 ）. However, DCNVA was higher 3 months after Nd：YAG laser capsulotomy than that of 1 day before Nd：YAG laser capsulotomy （P〈0. 05 ）. There was no significant correlations between DCNVA and IOL movement 3 months after IOL implantation, 1 day before Nd： YAG laser capsulotomy and 3 months after Nd：YAG laser capsulotomy（rl =-0. 150,P1 =0. 486,r2 =-0. 320,P2 =0. 122,r3 = -0. 100,P3 = 0. 633 ）. Conclusions The shifting amplitude of 1CU AIOL markedly declines due to PCO. No clinically significant influence of Nd ： YAG laser capsulotomy on the shifting amplitude of 1CU AIOL is found. DCNVA can improve after Nd：YAG laser capsulotomy. Multiple inter-related factors concerning pseudophakic accommodation may influence DCNVA.
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2013年第4期377-380,共4页
Chinese Journal Of Experimental Ophthalmology
