摘要
背景 玻璃体切割联合硅油填充眼易诱发和加速白内障的形成，白内障联合硅油取出术前人工晶状体（IOL）屈光度的准确测算是术眼获得术后良好视觉质量的关键。目的 研究不同仪器和不同IOL计算公式在硅油填充合并白内障眼行白内障摘出联合IOL植入术前IOL屈光度测算的差异，并测算术前预测IOL屈光度与术后术眼屈光度的误差，为临床相关工作提供参考依据。方法 采用前瞻性非随机对照的研究方法，于2011年8月至2013年10月在苏州大学附属第二医院连续纳入玻璃体切割术后硅油填充合并白内障者36例36眼，患眼均于硅油乳化后4个月～2年拟行白内障超声乳化＋IOL植入＋硅油取出术，术前分别用IOLMaster及A型超声联合手动角膜曲率计（MK）测量术眼眼轴长度（AL）、角膜曲率（CC）和前房深度（ACD）等生物学参数，分别采用SRK-Ⅱ、SRK/T、Hoffer Q、Holladay 1和Haigis计算公式和预留的屈光度计算拟植入的IOL屈光度，分析和比较IOLMaster及A型超声联合MK用上述计算公式测算的IOL理论屈光度值与术后术眼实际屈光度值的平均预测误差（MPE）和平均绝对屈光误差（MAE）。结果 A型超声＋MK和IOLMaster测得的AL分别为（25.21±1.02）mm和（25.43±0.90）mm，ACD分别为（3.07±0.62）mm和（3.22±0.38）mm，A型超声＋MK测量的AL和ACD值明显小于IOLMaster测量结果，差异均有统计学意义（均P＝0.000）。IOLMaster与A型超声＋MK测得的CC分别为（44.58±1.57）D和（44.56±1.62）D，差异无统计学意义（P＝0.568）。用IOLMaster测量时，SRK/T公式的MAE明显小于SRK-Ⅱ、Hoffer Q、Holladay 1和Haigis公式的MAE，差异均有统计学差异（P＝0.017、0.009、0.012、0.001）；Haigis公式的MAE明显大于SRK-Ⅱ、Hoffer Q和Holladay 1公式的MAE，差异均有统计学意义（P＝0.026、0.035、0.021）。用A型超声＋MK测量时，Haigis公式的MAE明显大于与SRK-Ⅱ、SRK/T、Hoffer Q和Holladay 1公式的MAE，差异均有统计学意义（P＝0.007、0.004、0.018、0.006）。用SRK-Ⅱ、SRK/T、Hoffer Q和Holladay 1公式计算时，IOLMaster与A型超声＋MK间测量的MAE≤1.0 D眼数比较差异均无统计学意义（χ2＝0.107、2.250、0.845、0.084，均P〉0.05）；用Haigis公式计算时，IOLMaster测量的MAE≤1.0 D眼数明显多于A型超声＋MK测量结果，差异有统计学意义（χ2＝4.431，P＝0.035）。结论 使用IOLMaster时SRK/T公式测算的IOL屈光度准确性最高，用A型超声＋MK测量时推荐使用SRK-Ⅱ、SRK/T、Hoffer Q和Holladay 1测算公式。
Background Silicon oil tamponade eyes following vitrectomy accelerate and induce lens opacification, so the accurate measurement and calculation of intraocular lens （IOL） diopter before cataract extraction＋ IOL implantation is very important for the recovery of visual function.Objective This study was to compare the differences of IOL powers measured and calculated by different apparatus and different IOL power formulas before cataract extraction＋ IOL implantation silicon oil tamponade combined with cataractous eyes.Methods A prospective, consecutive, nonrandomized study was performed.Thirty-six silicon oil tamponade with cataract eyes of 36 patients were included in the Second Affiliated Hospital of Soochow University from August 2011 to October 2013.Patients with silicone oil emulsification for 4 months to 2 years prepared to treat by cataract extraction＋ IOL implantation＋ silicon oil removal.Axial length （AL）, corneal curvature （CC） and anterior chamber depth （ACD） were measured with IOLMaster and A-scan with manual kerameter （MK） in the eyes for the prediction of IOL power by SRK-Ⅱ, SRK/T, Hoffer Q, Holladay 1 and Haigis formulas under the oral informed consent.The mean predictive error （MPE） and mean absolute refractive error （MAE） between predictive IOL diopters before operation and actual IOL diopters after operation were evaluated.Results The AL and ACD values measured by IOLMaster was （25.43±0.90）mm and （3.22±0.38）mm, which were significantly higher than （25.21±1.02）mm and （3.07±0.62）mm by A-scan＋ MK respectively, the difference between the two measure methods was statistical significance（both at P=0.000）. No significant difference was found in measured CC values between IOLMaster and A-scan＋ MK （[44.58±1.57]D vs.[44.56±1.62]D） （P=0.568）. When the parameters measured by IOLMaster were used, the MAE from SRK/T formula was smaller than that from SRK-Ⅱ, Hoffer Q, Holladay 1 and Haigis formulas （P=0.017, 0.009, 0.012, 0.001）, and the MAE from Haigis formula was significantly larger than that from SRK-Ⅱ, Hoffer Q and Holladay 1 formulas （P=0.026, 0.035, 0.021）. When measured by A-scan＋ MK, the MAE from Haigis formula was significantly larger than that from SRK-Ⅱ, SRK/T, Hoffer Q and Holladay 1 formulas （P=0.007, 0.004, 0.018, 0.006）. There was no significant difference in the number of eyes with MAE≤1.0 D between IOLMaster and A-scan＋ MK measurements under the calculation of SRK-Ⅰ, SRK/T, Hoffer Q and Holladay 1 formulas （χ2=0.107, 2.250, 0.845, 0.084, all at P〉0.05）. However, the number of eyes with MAE≤1.0 D was significantly increased in IOLMaster measurement compared with A-scan＋ MK under the calculation of Haigis formula （χ2=4.431, P=0.035）.Conclusions In silicon oil-filled cataract eyes, SRK/T formula appears to have a more accurate predictive value of IOL power than that of other formulas when employ IOLMaster; when use A-scan＋ MK measurement, the predictive value of IOL power seems to be better by using SRK-Ⅱ, SRK/T, Holladay 1 or Hoffer Q formulas.
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2017年第3期249-254,共6页
Chinese Journal Of Experimental Ophthalmology
关键词
生物测量/仪器
人工晶状体植入
眼屈光系统/生理
算式
白内障
硅油/应用
前瞻性研究
Biometry/instrumentation
Lens implantation, intraocular
Refraction, ocular/physiology
Algorithms
Cataract
Silicone oils/administration
Prospective studies
