黏度5500 mPas硅油填充眼超声生物学测量的准确性

背景 硅油填充眼超声生物学测量的准确性和可行性是眼科诊疗过程中的难题,对硅油眼性白内障行超声乳化联合人工晶状体(IOL)植入术时IOL度数的计算造成困难.一些大型医院常采用光学测量仪IOLMaster实现对硅油填充眼的生物学测量,但其对屈光介质严重混浊的病例仍无法进行测量.曾有研究者采用超声改良法或眼轴分段测量法进行估算,但其研究结果可能由于硅油黏度的不同而差异较大.目的 探讨超声对黏度5 500 mPas硅油填充眼生物学测量的计算方法,为超声法对不同黏度硅油填充眼进行生物学测量提供方法学参考依据. 方法 采用B型超声仪于37℃下对高度分别为20、24和28 mm的平衡盐溶液进行测量,并与黏度5 500 mPas硅油的相应测量高度进行比较,以得到计算硅油眼实际眼轴长度(AL)的公式.收集于2012年5月至2014年3月在青岛市海慈医疗集团接受黏度为5 500mPas硅油填充治疗的复杂性视网膜疾病患者30例32眼,按实际AL分为AL＜26 mm组(16例18眼)和AL≥26 mm组(14例14眼),分别于硅油取出术前1d行B型超声、IOL Master测量AL,并于术后3个月用A型超声及B型超声测量AL.对不同方法测量的AL值进行差异比较和相关分析,并对手术前后受检眼玻璃体腔长度和屈光度进行比较.结果 B型超声波在黏度5 500 mPas硅油中的传播速度为1 023 m/s,超声波在硅油眼与正常玻璃体腔中测算AL的校正系数为0.668,校正AL=角膜顶点至晶状体后极或囊膜中央点距离+0.668×晶状体后极或囊膜中央点至黄斑距离.AL＜26 mm组和AL≥26 mm组受检眼用术前B型超声校正公式法、IOLMaster测量法、术后A型超声测量法和术后B型超声测量法测量的AL值的总体比较,差异均无统计学意义(F=0.108,P=0.955;F=0.011,P=0.998);硅油取出术前,B型超声校正公式法测量的AL值与IOLMaster测量法、术后B型超声测量法和术后A型超声测量法间测得的AL值均呈明显正相关(AL＜26 mm组:r=0.876、0.921、0.809,均P＜0.01;AL≥26 mm组:r=0.943、0.956、0.955,均P＜0.01).硅油取出术前1d,B型超声测量的玻璃体腔长度校正值为(20.78±2.13)mm,硅油取出术后3个月测量的玻璃体腔实际长度为(20.89±2.16) mm,二者间差异无统计学意义(t=0.795,P=0.219).受检眼中16眼行IOL植入术后平均屈光度为(-1.25±1.69)D,与术前保留的(-1.50±0.00)D比较,差异无统计学意义(t=0.585,P=0.284).结论 B型超声法对硅油填充眼的生物学测量准确、简便,用于临床的可行性较好.     

A超分段测量法及IOL Master在硅油填充眼生物测量中的应用

目的 评价应用A超分段测量法及光学相干生物测量仪(IOLMaster)对硅油填充眼进行生物测量的准确性.方法 前瞻性选取2008年1月至12月拟行硅油取出术的患者总共29例29眼,手术前、后使用眼科A/B超及IOL Master两种方式测量眼轴,并分别进行比较;A超分段测量法计算公式为:硅油填充眼的眼轴长度=前房深度+晶状体厚度+0.644×硅油泡的表观长度(声速值1532m/s)+硅油泡下水层的厚度.结果 用眼科A超分段测量法测得手术前、后的眼轴长为(26.11±2.85)mm、(26.06±2.80)mm,其差值为(0.06±0.27)mm(P =0.226);IOLMater测得手术前、后的眼轴长为(26.37±2.80)mm、(26.29±2.77)mm,其差值为(-0.04±0.15)mm(P=0.315);IOLMaster测得的术前和术后眼轴长与术后A超眼轴长差值分别为(0.18±0.17)mm(P ＜0.01)、-0.23±0.13 mm(P＜0.01).两种方法在术前术后测得的眼轴长度结果均显示高度相关(相关系数＞0.99).结论 A超分段测量法及IOL Master均可对硅油填充眼进行准确可靠的眼轴测量.     

IOL Master在硅油填充眼生物测量中的应用

目的评价IOL Master对硅油填充眼进行生物测量的准确性。方法前瞻性选取2008年1月至12月间在我院行硅油取出术的硅油填充眼患者29例（29只眼）,在术前、术后均用IOLMaster测量眼轴长度,并用A超测量术后的眼轴,对结果进行比较。结果有6只眼因晶状体混浊明显或不能固视而未能测得眼轴,其余患眼IOL Master测得的术前、术后眼轴长分别为（26.37±2.80）mm及（26.29±2.77）mm,差值为（-0.04±0.15）mm（-0.36～0.23mm）（P=0.239）,相关系数为0.999;A超测得的患眼术后眼轴长度为（26.06±2.80）mm,患眼术前IOL Master与术后A超测得眼轴长度的差值为（0.18±0.17）mm（-0.21～0.58mm）（P〈0.01）,相关系数为0.998;术后IOL Master与A超测得眼轴长度的差值为（-0.23±0.13）mm（-0.54～-0.05mm）（P〈0.01）,相关系数为0.999。结论 IOL Master光学生物测量法可对硅油填充眼进行准确可靠的生物测量。     

IOL-Master测量硅油填充眼屈光结果分析

目的评价IOL—Master测量硅油填充眼屈光度数的准确性并分析不同因素与术后屈光误差的关系。方法29例（29眼）硅油填充眼行硅油取出联合人工晶状体（IOL）植入术,术前用IOL—Master进行IOL测量。根据不同病因、硅油放置时间、眼轴、术后并发症等因素进行分类,研究术后视力恢复情况及测量误差产生的原因。结果术后视力较术前均有不同程度的提高,屈光度数的平均预测误差为0．329±0．846（-1．5～-2．0D）,眼轴长度（P〉0．05）、病因[裂孔源性（t=0．478,P=0．637）、黄斑裂孔（t=0．135,P=0．895）]、是否近视（t=0．435,P=0．667）与术后产生的屈光误差均无相关性,硅油存留时间〈1年者术后矫正视力恢复好。结论硅油填充眼患者采用硅油取出联合IOL植入术对视力有一定提高,IOL—Master测量硅油填充眼IOL度数是相对准确、安全、方便的方式。     

不同测量仪器和不同IOL屈光度计算公式对硅油填充合并白内障眼IOL屈光度测算的比较

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、HofferQ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≤1.0D眼数比较差异均无统计学意义(x2=0.107、2.250、0.845、0.084,均P＞0.05);用Haigis公式计算时,IOLMaster测量的MAE≤1.0D眼数明显多于A型超声+MK测量结果,差异有统计学意义(x2=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.     

硅油填充眼超声生物测量法的临床观察

目的 探讨硅油填充眼超声生物测量法的临床效果.方法 系列病例研究.根据超声测距原理,对相同高度的平衡盐溶液和硅油进行对比研究,计算出其间的测距比例常数(0.674),从而建立硅油填充眼矫正眼轴的测算公式,即公式=ab+0.674×bc(a、b、c分别为角膜顶点、晶状体后极或囊膜中央点、黄斑表面).然后,采用Vivid 7型超声诊断仪对150例(150只眼)硅油填充眼取出硅油前后的眼轴和玻璃体腔前后径进行测量,根据眼轴的长度分为两组,即第1组患者的眼轴长度<25 mm,第2组患者的眼轴长度≥25 mm.其中76只眼在硅油取出联合人工晶状体(IOL)植入术前,按Sanders retzlaff kvaff T公式计算出IOL度数,将术后实际屈光状态与术前预见屈光状态进行比较.两组患者术前后眼轴长度、玻璃体腔前后径、屈光状态进行比较,采用配对t检验.结果 150例(150只眼)硅油填充眼患者术后随访3个月,视网膜病变稳定.生物测量结果:第1组111只眼,硅油取出术前矫正眼轴长度为21.10～24.90 mm,平均(22.77±1.00)mm;硅油取出术后眼轴长度21.00-24.70 mm,平均(22.76±0.99)mm;两者之间的差异无统计学意义(t=0.518,P>0.05);111只眼取出硅油前与后玻璃体腔前后径的超声测量值分别为(26.57±2.14)mm和(17.90±1.38)mm,后者与前者的比值为0.673 78.第2组39只眼,硅油取出术前矫正眼轴长度为25.00～30.58 mm,平均(26.52±1.31)mm;硅油取出术后眼轴长度为25.00～30.59mm,平均(26.53±1.29)mm;两者之间的差异也无统计学意义(t=0.109,P>0.05);39只眼硅油取出前与后玻璃体腔前后径的超声测量值分别为(32.01±2.90)mm和(21.57±2.04)mm,后者与前者的比值为0.673 95.两组76例(76只眼)IOL植入术后患者随访3个月以上,其术后实际屈光状态与术前预见屈光状态分别进行比较,差异均无统计学意义(t_1=0.253,P_1>0.05;t_2=0.209,P_2>0.05).结论 硅油填充眼的超声生物测量法准确、简便,临床应用效果好.     

硅油眼眼轴长度的测量研究

目的 探讨硅油眼眼轴长度的测量方法,评价IOL Master测量硅油眼眼轴长度的准确性.方法 选择2009年1月至2010年1月于我院行玻璃体切割联合硅油填充术患者26例(30眼),术前1d分别应用接触式A超和IOL Master测量眼轴长度,用SRK/T公式计算IOL屈光度.于术后1个月,IOL Master复测眼轴长度,比较三者眼轴长度的差异,并观察患者的屈光状态.结果 应用接触式A超测得的眼轴长度为(24.01±2.62)mm,应用IOL Master术前和术后所测得的眼轴长度分别为(24.23±2.91)mm、(24.38±3.18)mm,差异无统计学意义(x2=2.684,P=0.261).植入IOL且取出硅油的患者6例(7眼)根据术前接触式A超测算的预测屈光误差(mean predictive error,MPE)为(0.45±0.43)D,绝对屈光误差(mean absolute error,MAE)为(0.51±0.36)D,根据术前IOL Master测算的MPE为(0.19±0.39)D,MAE为(0.33±0.26)D,根据硅油填充术后IOLMaster测算MPE和MAE分别为(0.11 ±0.35)D、(0.29±0.20)D,三者差异均无统计学意义(均为P＞0.05).结论 IOL Master能准确测量硅油眼的眼轴长度,有无硅油不影响其测量结果.     

坐位及卧位时硅油填充眼眼轴A型超声测量的比较

目的比较坐位与卧位时硅油填充眼眼轴的A型超声测量值的差异,为更准确进行硅油填充眼眼轴测量提供指导。方法对2012年4月至2013年4月于我院治疗的69例(71只眼)硅油填充术后并发白内障患者分别进行眼轴的坐位A型超声测量、卧位A型超声测量及光学生物测量仪(IOL Master)测量,应用t检验和Bland-Altman分析评价两种体位下所获得的A型超声结果的准确性。结果坐位A型超声测量眼轴长约20.30～31.56 mm,平均(24.19±2.47)mm;卧位A型超声测量眼轴长约13.93～27.90 mm,平均(22.28±2.30)mm;IOLMaster测量眼轴长约20.64～31.98 mm,平均(24.34±2.50)mm。坐位与卧位A型超声的眼轴测量值差异有统计学意义(P<0.05),坐位A型超声测量值与IOL Master眼轴测量值差异有统计学意义(P<0.05),卧位A型超声测量值与IOL Master眼轴测量值差异有统计学意义(P<0.05)。Bland-Altman分析表明坐位A型超声与IOL Mas-ter一致性较卧位A型超声与IOL Master更佳。结论硅油填充术后并发白内障患者使用A型超声进行眼轴测量时,除需要调整声速外,建议选择坐位,以保证测量结果的准确性。     

IOL Master与A超测量硅油眼眼轴的对比研究

目的:比较评估A超及IOL Master在硅油眼患者眼轴长度测量的精确性,探讨IOL Master在硅油眼人工晶状体度数计算中的临床应用价值。方法:分析我院2012-06/12间收治的硅油眼白内障手术患者30例30眼,分别用接触式A超及IOL Master测量术前、术后眼轴长度比较两者之间差异。并将术前IOL Master测量自动获取IOL度数后预估患眼屈光状态与术后1mo复查患者屈光状态(等效球镜度数)行统计学分析。结果:A超与术前IOL Master测量眼轴有显著性差异,使用IOL Master测量术前、术后眼轴无显著差异,术后使用A超及IOL Master测量眼轴之间无显著性差异。采用IOL Master术前测量眼轴所得人工晶状体度数植入人工晶状体术后屈光状态与术前预估无明显差异。结论:IOL Master测量眼轴较A超有明显优越性,但对于某些不能使用IOL Master测量的病例仍需结合A超等其他测量方法辅助测量。     

A超分段测量法在硅油填充眼生物测量中的应用

目的 评价应用A超分段测量法对硅油填充眼进行生物测量的准确性.方法 前瞻性选取2008年1月至12月间在我院行硅油取出术的硅油填充眼患者29例(29眼),在术前、术后3个月均用眼科A超测量眼轴长度并进行比较;其中硅油填充眼的A超分段测量法采用仰卧位接触法测量,硅油泡长度采用1 532 m·s-1的声速值测得表观长度后乘以0.644,得到硅油泡的实际长度,并考虑到硅油泡下水层的厚度,即计算公式为:硅油填充眼的眼轴长度=前房深度+晶状体厚度+0.644×硅油泡的表观长度+硅油泡下水层的厚度.结果 用眼科A超分段测量法测得术前、术后的眼轴长度平均为(26.11±2.85)mm、(26.06±2.80)mm;同一患眼术前、术后眼轴长度的差值平均为(0.06±0.27)mm,术前、术后测得结果高度相关,相关系数为0.995,差异无统计学意义(P=0.283＞0.05);患眼术后与对侧眼眼轴长度的差值水平为(1.69±2.28)mm,双眼眼轴长度相关性差,相关系数为0.549,差异无统计学意义(P=0.816＞0.05).结论 A超分段测量法可对硅油填充眼进行准确可靠的生物测量.     

Refractive outcome of silicone oil removal and intraocular lens implantation using laser interferometry

PURPOSE: To evaluate the refractive outcome of silicone oil removal and intraocular lens (IOL) implantation using laser interferometry. METHODS: Thirteen silicone oil-filled eyes of 12 patients were included in the study. IOL power calculation was performed using laser interferometry (IOLMaster V1.1; Carl Zeiss, Jena, Germany). All of these eyes underwent silicone oil removal and cataract extraction with IOL implantation. Post-operative refraction was evaluated. RESULTS: The mean deviation of the final post-operative refraction (spherical equivalent) was -0.30+/-0.91 D (range, -1.87 to +1.3) at 12 weeks. The mean axial length of the eyes was 22.99+/-0.84 mm (range, 22.07-25.24 mm). No major complications occurred intra- or post-operatively. CONCLUSION: Laser interferometry appears to be a feasible and satisfactorily accurate method to calculate IOL power in some silicone oil-filled eyes. Further studies comparing this technique to others are warranted.     

Signal quality of biometry in silicone oil-filled eyes using partial coherence laser interferometry

PURPOSE: To assess the practical feasibility and signal quality of axial length measurements by partial coherence laser interferometry in silicone oil-filled eyes with previous complicated vitreoretinal surgery. SETTINGS: Department of Ophthalmology, University Cologne, Cologne, Germany. METHODS: Using a Zeiss IOLMaster, axial length measurements and signal-to-noise ratios of optical biometry in silicone oil-filled eyes (n=45) and contralateral eyes without tamponade (n=41) were analyzed. RESULTS: Axial length measurements with signal-to-noise ratio > or =2 were feasible in 41 of 45 silicone oil-filled eyes (91%) and 37 of 41 eyes without tamponade (90%). Cataract, central retinal detachment, vitreous hemorrhage, and emulsified oil droplets attached to the intraocular lens were reasons for failure of partial coherence laser interferometry. The signal-to-noise ratio of the first 2 measurements was significantly smaller (P=.04) in silicone-filled eyes (4.4 +/- 2.0) than in eyes without tamponade (5.5 +/- 3.0). Axial lengths of the oil-filled eye and the contralateral eye showed a significant intraindividual correlation (P<.0001, Spearman r=0.84). CONCLUSIONS: Partial coherence laser interferometry shows good clinical practicability in silicone oil-filled eyes with previous complicated vitreoretinal surgery. Further studies are needed to assess the reliability of these measurements with regard to postoperative refraction after combined oil removal and cataract surgery.     

Agreement of IOL power and axial length obtained by IOLMaster 500 vs IOLMaster 500 with Sonolink connection

Background

The accurrate and expedient ocular biometry is essential for modern cataract surgery. IOLMaster 500, one of the most popular partial coherence interferometry (PCI) device, has been widely used. However, with the PCI device, it is difficult to obtain the axial length through densely opaque media. With the current version of IOLMaster 500, a unique feature is added to link with the Synergy immersion A-scan ultrasound (sonolink connection). In case of failure to measure axial length by IOLMaster 500, the axial length can be obtained by ultrasound, and then transferred to IOLMaster 500 for the IOL power calculation. This study aims to compare the results and evaluate the agreement between IOL power and axial length obtained by IOLMaster 500 and IOLMaster 500 with sonolink connection.

Methods

A prospective study of 60 eyes in 60 mild-to-moderate cataract patients was conducted under Institutional Ethics Committee approval. Keratometry (K) and axial length (AL) of all eyes were measured using IOLMaster 500 (Carl Zeiss, Germany), then IOL power was generated using Holladay 1 formula (group 1). After 5 min, the K measurements were repeated with IOLMaster 500 and the AL were measured again using the Synergy A-scan ultrasound (Accutome, USA). Then, the AL data were transferred to IOLMaster 500 via the sonolink connection to generate the IOL power using the same setting (group 2). The IOL power and AL were compared between the two groups, and the agreement was evaluated using intraclass correlation coefficient (ICC) and the Bland–Altman method.

Results

The mean IOL power in group 1 was 21.04?+?2.36 D and group 2 was 21.03?+?2.36 D. The mean AL in group 1 was 23.35?+?0.86 mm and in group 2 was 23.36?+?0.86 mm. There was no statistically significant difference in IOL power and AL between the two groups. The agreements in IOL power and AL between both groups were high (ICCs?=?0.997 for IOL power and 0.993 for AL)

Conclusions

The IOL power and AL derived from both groups were similar. The agreements between them were high.     

A超测量硅油填充眼眼轴准确性研究

目的:探讨A超在硅油填充眼眼轴测量中的准确性。方法:由于硅油与玻璃体的屈光指数不同,超声波在硅油中的传播速度发生变化,从而可导致眼轴的测量值出现偏差,采用实验的方法对超声波在硅油中的传播速度进行测量,进而对眼轴值进行修正。选取24例行玻璃体切割伴硅油填充术的患者,应用A超分别对患眼、健眼进行眼轴测量,并对所测得患眼眼轴值进行修正,应用IOL-Master对患眼眼轴进行测量,对各眼轴长度进行比较。结果:A超测得患眼眼轴为31.97±6.07mm,修正后患眼眼轴为23.94±4.17mm,健眼眼轴为23.74±1.40mm,IOL-Master测量的眼轴长度为24.77±0.82mm。结论:A超经修正后可准确测量硅油眼的眼轴长度,可以应用于IOL-Master不能测量的病例。     

Partial coherent interferometry--an alternative method for intraocular lens power calculation performed by ultrasonography

PURPOSE: To compare axial length estimated by means of Zeiss IOLMaster and A-scan ultrasonography and anticipate postoperative refraction after IOL implantation with refraction measured after operation. MATERIAL AND METHODS: 26 patients were analyzed. Measurement of axial length was performed by Zeiss IOLMaster and A-scan ultrasonography. Preoperative refraction was determined by both methods based on SRK/T calculation formula and 119.0 and 120.5 A-constant for IOL. Postoperative refraction was expressed as a spherical equivalent and was obtained by autokeratorefraktometry in the first day after cataract surgery. RESULTS: Mean axial length measured by IOLMaster was longer by 0.06 mm in compared to ultrasound estimation (p < 0.001). The correlation between pre-operative refraction values determined by IOLMaster and post-operative measurements was statistically significant (p = 0.03). CONCLUSIONS: Measurement of axial length performed by IOLMaster is longer than by ultrasonography. IOLMaster seems to be more reliable method than ultrasonography in intraocular artificial lens calculation in cataract surgery.