超声乳化联合IOL植入术围手术期瞳孔直径和反应的变化

探究晶状体超声乳化联合人工晶状体（IOL）植入术围手术期瞳孔直径、反应的变化。方法：前瞻性临床研究。收集于2016年1-9月上海交通大学医学院附属第九人民医院眼科行超声乳化联合IOL植入术的连续白内障和高度近视透明晶状体置换患者。采用动态瞳孔测量仪（Metro-vision MONCV3）测量术前、术后1周、术后1个月在4种光照度下（0、1、10和100 cd/m2 ）的瞳孔直径，并检测瞳孔反应（如瞳孔初始直径、收缩幅度、收缩潜伏期、收缩持续时间、收缩速度、扩张潜伏期、扩张持续时间和扩张速度等）。采用重复测量方差分析、Pearson相关分析及Spearman相关分析对数据进行分析。结果：共纳入患者53例（53眼）。在4种光照度下，术前瞳孔直径随年龄增加而下降（r0=-0.467，P0<0.001；r1=-0.383，P1=0.005；r10=-0.374，P10=0.006；r100=-0.312，P100=0.023）。 4种光照强度下瞳孔直径手术前后总体差异有统计学意义（F0=206.9，P0<0.001；F1=106.8，P1<0.001； F10=41.7，P10<0.001；F100=36.7，P100<0.001），与术前相比，4种光照强度下瞳孔直径术后1周、1个月均下降（均P<0.001）。手术前后瞳孔反应的初始直径、收缩幅度、收缩和扩张速度总体差异有统计学意义（F初始直径=99.5，P初始直径<0.001；F收缩幅度=36.2，P收缩幅度<0.001；F收缩速度=51.9，P收缩速度<0.001；F扩张速度=23.8，P扩张速度<0.001），与术前相比，术后1周、1个月初始直径、收缩幅度、收缩和扩张速度均下降（均P<0.001）。结论：超声乳化联合IOL植入术后1个月内可引起瞳孔缩小，瞳孔反应的收缩、扩张速度变慢，为IOL设计中确定有效光学区范围提供依据。

Changes in Pupil Diameter and Reactions during the Phacoemulsification Stage with Posterior Chamber Intraocular Lens Implantation

To investigate changes in pupil diameter and reaction parameters following phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Methods: This prospective study included patients who underwent consecutive cataract and high myopia transparent crystalline lens replacement and were scheduled to undergo phacoemulsification from January to September 2016 in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Pupil diameter under four controlled illumination levels (0, 1, 10, and 100 cd/m2 ) and reaction parameters (initial diameter, amplitude of contraction, latency of contraction, duration of contraction, velocity of contraction, latency of dilatation, duration of dilatation, and velocity of dilatation) were measured preoperatively and 1 week and 1 month postoperatively using computerized dynamic pupillometry (Metro-vision MONCV3). A Pearson correlation coefficient, Spearman correlation coefficient, and repeated measures analysis of variance were used to analyze the data. Results: In total, 53 eyes from 53 patients were included in this study. Under the four conditions of illumination, pupil diameter decreased as age increased (r0=-0.467, P0<0.001; r1=-0.383, P1=0.005; r10=-0.374, P10=0.006; r100=-0.312, P100=0.023). The overall differences in pupil diameters before and after surgery under 4 kinds of illumination intensity were statistically significant (F0=206.9, P0<0.001; F1=106.8, P1<0.001; F10=41.7, P10<0.001; F100=36.7, P100<0.001). Compared to preoperative measurements, postoperative pupil diameters were reduced at 1 week and 1 month under the four conditions of illumination (P<0.001). The overall differences in the initial diameter and constriction amplitude of pupil reaction were reduced, and the differences in pupil contraction and dilation velocity reaction were statistically significant (Finitial diameter=99.5, Pinitial diameter<0.001; Fcontraction amplitude=36.2, Pcontraction amplitude<0.001; Fcontraction velocity=51.9, Pcontraction velocity<0.001; Fdilation velocity=23.840, Pdilation velocity<0.001). Compared to preoperative measurements, the initial diameter and constriction amplitude of pupil reaction were reduced, and pupil contraction and dilation velocity reaction declined at 1 week and 1 month postoperatively (P<0.001). Conclusions: Pupil diameters are smaller and pupil constriction and dilation velocity are slower within 1 month postoperatively. These data may provide a clinical basis for determining the effective optical range in the design of IOLs.