【作者】 徐科；

【导师】 陈彬川；

【作者基本信息】 郑州大学 ， 眼科学， 2011， 硕士

【摘要】 背景和目的随着白内障手术技术的不断完善,人们生活水平的不断提高和人工晶状体设计制造工艺的不断改进,白内障手术已由过去的单纯复明手术向屈光性手术过渡。多焦点人工晶状体应用于屈光性白内障手术,可使患者获得良好的裸眼全程视力,减少对眼镜的依赖,但仍有部分患者术后未脱镜,这既给患者带来了痛苦,也加剧了临床工作的风险。本研究旨在通过研究影响脱镜率的因素,为临床工作提供指导性意见。方法本文为回顾性研究。分析自2006年6月到2009年4月在我科行白内障超声乳化吸出联合ReSTOR多焦点人工晶状体植入术的患者182例(222只眼),其中年龄相关性白内障155例(190只眼),先天性白内障5例(10只眼),小梁切除术后白内障患者15例(15只眼),伴有糖尿病的白内障患者7例(7只眼)。记录戴镜人数及戴镜率；戴镜人群的屈光状态及其裸眼远、近视力；戴镜人群术前、术后眼球生物学测量；戴镜人群眼部并发症。统计学处理：对上述观察指标的结果采用t检验和χ2检验,全部资料应用SPSS 13.0统计软件包进行统计学处理。结果1.术后戴镜36例(39只眼),单眼植入ReSTOR多焦点人工晶状体者术后戴镜率23.2%(33/142),双眼植入者戴镜率为7.5%(3/40),两组之间差异具有统计学意义(χ2=4.872,P=0.027)。2.戴镜者裸眼远视力平均0.46,裸眼近视力平均0.41,视远矫正视力的等效球镜度数平均(+0.38±1.25)D,等效球镜度数与裸眼远视力、近视力显著负相关(r=-0.615,-0.427；P<0.05)。3.年龄相关性白内障患者术前、术后眼轴测量差异有统计学意义(t=3.262,P<0.05),而角膜曲率测量差异无统计学意义(-0.248,P>0.05)。4.戴镜者裂隙灯检查发现瞳孔异常4眼,后发性白内障6眼,人工晶状体偏心3眼。结论1.双眼植入多焦点人工晶状体可降低戴镜率2.眼轴测量误差可能导致术后戴镜3.角膜曲率测量对戴镜率未造成明显影响4.手术并发症可能导致术后戴镜更多还原

【Abstract】 Background and ObjectivesAdvances in both intraocular lens (IOL) and phacoemulsification technology have enabled Cataract surgery and IOL implantation to become more of a refractive procedure. With implantation of multifocal intraocular lens in refractive cataract surgery, it can provide patients a satisfactory full range of vision and reduce dependence on glasses. However, some patients remain wear spectacles postoperatively, which not only brought suffering to patients, but also intensified the risk of clinical work. This research aims to study the factors that affect the rate of spectacle dependence and to provide guidance for clinical work.MethodsIt was a retrospective study.182 cases (222 eyes) with different types of cataracts underwent AcrySof ReSTOR IOL implantation after phacoemulsification during the period from June 2006 to April 2009. In this study, it include 155 cases (190 eyes) with age-related cataract,5 cases (10 eyes) with congenital cataract,15 cases (15 eyes) with complicated cataract and 7 cases (7 eyes) with diabetic cataract. The number and rate of spectacle dependence, refractive status, uncorrected distance and near visual acuity, variations in ocular biometry and ocular complications were recorded. Statistical analysis:Adoption of Chi-square test and t-test, all the materials were analyzed by software SPSS 13.0. Results1.36 cases (39 eyes) still wore spectacles after surgery.23.2%(33/142) of the patients who have been monocularly implanted with ReSTOR MIOL wore spectacles. 7.5%(3/40) of the patients who have been binocularly implanted with ReSTOR MIOL wore spectacles. There was a statistically significant difference between the two groups (χ2=4.872, P=0.027)2. The mean uncorrected distance and near visual acuity were 0.46 and 0.41 respectively. The mean spherical equivalent refraction of patients who wore spectacles was +0.38±1.25D. A significant negative correlation was observed between uncorrected visual acuity and spherical equivalent refraction (r=-0.615,-0.427; P< 0.05)3. The difference between pre- and post-operative axial length measurement was significant (t=3.262, P<0.05).However, no significant difference was found between pre- and post-operative corneal curvature measurement (t=0.248, P>0.05)4.4 eyes with pupil abnormalities and 3 eyes with intraocular lens decentration were observed.6 eyes developed the complication of posterior capsule opacification.Conclusion1. Binocular implantation of multifocal intraocular lens could reduce dependence on spectacles.2. Axial length measurement error might lead to wearing spectacles after cataract surgery.3. Measurement of corneal curvature did not cause significant effect on the rate of wearing spectacles.4. Surgical complications might lead to wearing spectacles after cataract surgery.更多还原