Repeatability and agreement of two anterior segment OCT in myopic patients before implantable collamer lenses implantation

AIM: To evaluate the intra-operator repeatability of time domain and swept-source Fourier domain anterior segment optical coherence tomography(AS-OCT), namely, Visante ASOCT and Casia SS-1000 OCT, in measuring the preoperative parameters of implantable collamer lens(ICL) in myopic eyes, as well as the agreement between the two devices.METHODS: A total of 97 eyes from 49 myopes were investigated in this prospective case series study. The anterior chamber depth(ACD), angle-to-angle distance(ATA), pupil diameter(PD) and crystalline lens rise(CLR) in all subjects were measured for three times during one session by the same operator. The repeatability was evaluated using the within-subject standard deviation(Sw), repeatability limits and intraclass correlation coefficients(ICC). The agreement between the two systems was evaluated using the Bland-Altman plots and 95% limits of agreement(Lo A).RESULTS: The repeatability limits of Visante AS-OCT in measuring ACD, ATA, PD and CLR were 0.099, 0.141, 0.304, and 0.079 mm, respectively. The repeatability limits of Casia SS-1000 OCT in measuring ACD, ATA, PD, and CLR were 0.105, 0.127, 0.357, and 0.082 mm, respectively. Excellent repeatability could be attained in both devices, with the ICC>0.8 for all the measured variables. The interdevice agreement was excellent(P>0.05) for ACD and ATA, but poor(P<0.05) for PD and CLR.CONCLUSION: Good repeatability can be attained by time domain and swept-source Fourier-domain OCT for all the measured variables. Moreover, interdevice agreement analysis suggests that interchangeable measurements between two devices can be achieved for ACD and ATA, but not for PD and CLR;but the differences in measurements were not clinically significant.     

高度近视有晶状体眼后房型人工晶状体植入术后眼前节解剖变化

目的 分析高度近视眼患者植入有晶状体眼后房型人工晶状体（Visian ICL V4）术后眼前节解剖结构的变化.方法 本研究入选行有晶状体眼人工晶状体植入术的高度近视患者93例（175眼）,平均年龄（30.52 ±7.00）岁（18～48岁）,其中119眼接受ICL植入术,46眼接受Toric-ICL植入术.比较术前和术后1周前房容积（ACV）、前房深度（ACD）、房角角度（ACA）（3：00 ～9：00位方向）变化、ICL光学区后表面到晶状体前囊膜中央距离（拱高）、角膜-晶状体间距、虹膜-晶状体间距、人工晶状体等效球镜（pIOL SE）等各参数间的关系.结果 术前、术后1周ACV分别为（200.29±31.76） mm3及（116.49±21.88） mm3,ACV减少（t=48.456,P=0.000）.术前、术后ACD由（3.17 ±0.23） mm减少到（2.89±0.33） mm（t=12.237,P=0.000）,术前、术后房角由（36.40 ±4.90）°减少到（23.44 ±5.07）°（t=31.131,P=0.000）;术后ACV和术后ACD与术后ACA呈现正相关（分别为r=0.637,P=0.000;r=0.393,P=0.000）.术后的角膜-晶状体间距较术前增加（0.40 ±0.31） mm（t=-16.935,P=0.000）,其与拱高呈正相关（r=0.446,P=0.000）.多因素回归分析,拱高与角膜-晶状体间距比值、手术前后的瞳孔变化率是独立的手术前后角膜-晶状体间距变化的影响因素（分别是P =0.001和P=0.048）.结论 ICL植入术后,虹膜平面抬升,使前房容积变小和房角变窄.     

Sensitized heat shock protein 27 induces retinal ganglion cells apoptosis in rat glaucoma model

AIM: To investigate the relationships between the changes of heat shock protein 27 antibody (anti-HSP27) in serum/cerebrospinal fluid (CSF), intraocular pressure (IOP), retinal ganglion cell (RGC) apoptosis in a rat glaucoma model and disclose the underlying pathogenesis of glaucoma. METHODS: A total of 115 Wistar rats were randomly divided into 4 groups. Group 1 was the ocular hypertension group by condensing 3 episcleral & limbal veins or episcleral area of right eye (HP group, n=25) and sham operation group with conjunctiva incision without coagulation (n=25). Group 2: HSP27 or dose-matched PBS was injected into the vitreous (V-HSP27 group, n=15; V-PBS group, n=15). Group 3: HSP27 and complete Freund’s adjuvant or dose-matched PBS was injected subcutaneously into the hind limb accompanied intraperitoneal injection of pertussis toxin [sensitized group (I-HSP27 group), n=15; I-PBS group, n=15)]. Group 4 was normal group without any treatment (n=5). IOPs of the rats were measured before, day 3, weeks 1, 2, 4, 6, and 8 after treatment. Paraffin-embedded sections were prepared for HE staining and RGCs apoptosis were detected by TUNEL. Anti-HSP27 level in serum and CSF were examined by ELISA. RESULTS: IOPs were elevated significantly in HP and V-HSP27, V-PBS groups (P<0.01) and positively related to anti-HSP27 levels in serum and CSFs. Anti-HSP27 levels in serum and CSF were elevated significantly in I-HSP27 group compared to other groups (P<0.05). However, the IOPs did not show any relationship with the high-level anti-HSP27 in serum and CSFs. RGC apoptosis were all elevated significantly in the HP, V-HSP27, V-PBS and I-HSP27 groups and also positively relative with anti-HSP27 level in serum and CSFs except that high-level of anti-HSP27 in the serum of I-HSP group. CONCLUSION: The increases of anti-HSP27 levels in serum and CSFs both promote IOP escalation and the increase of RGC apoptosis in retina when anti-HSP27 is at low level. The case of high-level anti-HSP27 is opposite and shows protective function in preventing IOP increase and RGC apoptosis.     

Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment

PURPOSE: To compare anterior segment parameters using quantitative imaging by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). SETTING: Tertiary-care glaucoma research center. METHODS: Sixty-three eyes of 63 subjects had anterior segment evaluation by AS-OCT (Visante-Zeiss) and UBM (Paradigm). Central corneal thickness (CCT), anterior chamber depth (ACD) (measured from the central corneal endothelium to the anterior lens capsule), and the peripheral iridocorneal angles (temporal and nasal) were assessed and compared. RESULTS: There was an excellent correlation between AS-OCT and UBM measurements for the nasal angle (r = 0.84; P<.0001), temporal angle (r = 0.86; P<.0001), ACD (r = 0.97; P<.0001), and CCT (r = 0.91; P<.0001). There was no significant difference (paired t test) between the mean ACD, CCT, and angle parameters measured by AS-OCT or UBM. The mean values of the parameters measured by AS-OCT and UBM were, respectively, as follows: nasal angle, 26.25 degrees +/- 11.0 (SD) and 28.27 +/- 11.3 degrees (P = .3); temporal angle, 25.1 +/- 11.4 degrees and 28.3 +/- 13.5 degrees (P = .15); ACD, 2.85 +/- 0.5 mm and 2.78 +/- 0.5 mm (P = .2); and CCT, 512 +/- 46 microm and 502 +/- 46 microm (P = .25). The AS-OCT images showed sharper definition of the scleral spur than the UBM images. CONCLUSION: Anterior segment optical coherence tomography and UBM can both be used for anterior segment measurements and yielded comparable results.     

有晶状体眼人工晶状体植入术后拱高及其影响因素研究

目的:探讨有晶状体眼人工晶状体(V4c型ICL)植入术后拱高的变化及其影响因素。方法:回顾性分析山西省眼科医院2015年7月至2018年12月中度及高度近视行V4c型ICL植入术60例(118只眼)的临床资料。术眼屈光状态为等效球镜度(-11.26 ±3.87)D。观察术后拱高随时间的变化趋势及可能的影响因素,并对比由...     

Pentacam和UBM在ICL手术患者术前中央前房深度测量的比较

目的　探讨Ｐｅｎｔａｃａｍ与ＵＢＭ在高度近视拟行可植入式角膜接触镜（ｉｍｐｌａｎｔａｂｌｅｃｏｌｌａｍｅｒｌｅｎｓ,ＩＣＬ）手术患者中中央前房深度（ｃｅｎｔｒａｌａｎｔｅｒｉｏｒｃｈａｍｂｅｒｄｅｐｔｈ,ＣＡＣＤ）测量中的差异性及一致性。方法　选取高度近视拟行ＩＣＬ手术患者５４例（１０８眼）,分别采用Ｐｅｎｔａｃａｍ和ＵＢＭ测量该类患者ＣＡＣＤ,采用ＳＰＳＳ１９．０统计学软件进行分析,计量数据进行正态检验,对两种仪器所测ＣＡＣＤ进行配对样本ｔ检验及直线相关分析,患者屈光度（等效球镜）及ＣＡＣＤ进行相关性分析,应用Ｂｌａｎｄ－Ａｌｔｍａｎ法分析评价两种仪器测量方法的一致性。结果　对Ｐｅｎｔａｃａｍ所测ＣＡＣＤ值为（３．２０３±０．２３２）ｍｍ,ＵＢＭ所测ＣＡＣＤ值为（３．１５６±０．２３３）ｍｍ,两者测量方法所测值差异有统计学意义（ｔ＝５．６８１,Ｐ＜０．０５）,但根据两种测量方法相关性分析及Ｂｌａｎｄ－Ａｌｔｍａｎ法表明两种测量方法有很好的相关性和一致性（ｒ＝０．９３１,Ｐ＜０．０５）。结论　Ｐｅｎｔａｃａｍ与ＵＢＭ分别作为光学测量仪器和超声测量仪器所得测量结果相似,都可以用于高度近视拟行ＩＣＬ手术患者ＣＡＣＤ的测量,但两种仪器各有优缺点,使用时可以互相辅助应用。     

Comparison of IOL master and ultrasound biomi - croscopy in anterior chamber depth measurement

AIM: To compare the measurement of anterior chamber depth (ACD) inclusive of corneal thickness using intraocular lens (IOL) master and ultrasound biomicroscopy (UBM) and evaluate the repeatability of each method. METHODS: Two consecutive measurements of ACD were prospectively performed using IOL master and UBM in 60 eyes in 60 individuals. Mean values were compared using the paired t test. For each individual, ACD measurements was performed 5 times to estimate the repeatability of each method by a coefficient of variation (CV). RESULTS: The mean ACD was 2.95?.25mm with the IOL master and 2.96±0.22mm with the UBM. This difference was not statistically significant (P =0.631). The coefficient of variation (CV) was 0.56%±0.26% and 0.65%±0.36% in IOL master and UBM, respectively. CONCLUSION: The mean ACD of IOL master is the same as UBM. The repeatability of IOL master is better than UBM.     

Pentacam与AS-OCT测量眼前节生物参数的比较

目的：在两组人群中比较Pentacam眼前节分析仪与眼前节光相干断层扫描(AS-OCT)测量的角膜曲率及角膜散光、中央角膜厚度和前房深度的差异性、相关性及一致性,为临床使用提供参考。

方法：前瞻性临床研究。纳入青年近视术前检查者64例124眼、年龄相关性白内障患者61例85眼,先后使用Pentacam和AS-OCT进行测量,获得眼前节生物参数。在两组人群中采用配对样本t检验分别对两种仪器测量结果的差异性进行比较,所得数据的相关性采用 Pearson相关性分析,测量结果的一致性采用 Bland-Altman 分析。

结果：近视组两种仪器测得的陡峭角膜曲率(Ks)、平坦角膜曲率(Kf)、平均角膜曲率(Km)有显著差异(P<0.001),而白内障组测得的Ks、Kf、Km无差异(P>0.05),两组人群两种仪器测量的J₀(散光参数)、平均角膜厚度(CCT)、前房深度(ACD)均有差异(P<0.05),测得J₄₅(散光参数)无差异(P>0.05)。两组人群中两种仪器测量的Ks、Kf、Km、J₀、J₄₅、CCT及ACD均具有线性相关(P<0.001)。近视组测量的Ks、Kf、Km的一致性良好,而白内障组测量的Ks、Kf、Km的一致性较差。

结论：Pentacam和AS-OCT测量散光参数、CCT及ACD时具有较好一致性,可互换使用,而测量Ks、Kf、Km时的一致性受年龄相关因素影响,优先考虑选择Pentacam。     

中央孔型眼内镜植入术后拱高的影响因素

目的 探讨中央孔型眼内镜（ICL）植入术后中央拱高的影响因素及分析导致极端拱高的可能原因。设计 回顾性病例系列。研究对象 2018-2019年北京同仁眼科中心接受V4c型ICL植入术的患者138例（276眼）。方法 回顾患者术前眼部生物测量参数包括屈光度（SE）、角膜水平直径即白到白（WTW）、前房深度（ACD）、前房容积（ACV）、前房角（Angle）、眼轴长度（AL）、晶状体厚度（LT）及术中植入ICL的直径。术后1周用眼前节OCT测量患者的拱高（Vault）。采用多元逐步回归分析确定拱高值和眼部生物参数的相关性。按拱高大小分为三组,分别为低拱高组（＜250 μm）、正常拱高组（250~1000 μm）和高拱高组（>1000 μm）,对三组间眼部参数进行比较,分析造成极端低拱高和极端高拱高的可能影响因素。主要指标 术后拱高值。结果 术后1周平均拱高为（645±247）μm。多元逐步回归分析得到拱高的回归方程为：Vault（μm）=180.954×ACD(mm) +99.805×WTW（mm）-2517.5,调整r2为0.069。低拱高组、正常拱高组、高拱高组三组间的ICL直径（127.9±3.8 mm、127.3±3.6 mm、130.2±2.8 mm）和ACD（2.95±0.29 mm、3.19±0.24 mm、3.29±0.22 mm）均有统计学差异（P均＜0.05）;年龄、SE、Angle、ACV、WTW、CCT、K1、K2差异无统计学意义（P均>0.05）。结论ACD和WTW是影响术后拱高的关键因素。同时,晶状体偏厚是极端拱高的可能影响因素。提示在临床上遇到非年龄性晶状体偏厚者,在ICL的选择上需要综合考虑更多因素。     

UBM量化观察有晶状体眼后房型人工晶状体植入术前后眼前节形态的变化

目的 应用超声生物显微镜(UBM)对比观察有晶状体眼后房型人工晶状体(ICL)植入术前后的多项眼前节指标变化,旨在评价ICL的安全性及稳定性。方法 前瞻性研究。收集2008年9月至2010年8月实施ICL植入矫正高度近视眼的患者30例（30只眼）,利用UBM观察并测量手术前、术后3个月及术后1年的中央前房深度(ACD)、小梁与虹膜夹角(TIA)、前房角开放距离（AOD500）、小梁与睫状体距离(TCPD)和虹膜与睫状体距离(ICPD),同时记录术后ICL距晶状体中央前表面的距离、ICL周边部距晶状体的距离及眼压等数据,并用裂隙灯显微镜随访检查。ICL周边部距晶状体的距离采用One-way ANOVA处理,余手术前后数据采用重复测量单因素方差分析及Bonferroni检验处理。结果 术前与术后3个月、术后1年ACD分别为(3.16±0.08) mm、(2.76±0.13) mm、(2.74±0.14) mm;AOD500分别为(0.45±0.04) mm、(0.41±0.04) mm、(0.41±0.03) mm;TIA(12点位)分别为35.0°±3.24°、32.47°±3.56°、32.40°±3.23°,三者术前与术后两时段相比差异均有统计学意义(P＜0.05);术后两时段相比差异无统计学意义(P＞0.05),TCPD、ICPD 术前、术后3个月和术后1年相比差异均无统计学意义(F=0.49,F=0.57;P＞0.05)。结论 应用UBM观察到的ICL手术前后眼前节形态结构的变化主要表现在ACD变浅、TIA及AOD的变窄,但尚在安全范围内,且经过1年多随访观察显示ICL术后眼前节形态结构的变化稳定且未发生相关并发症,但远期效果尚有待进一步随访。     

Allegro Oculyzer眼前节诊断系统评估ICL术后眼前节参数变化与眼压相关性分析

目的：研究有晶状体眼后房型人工晶状体植入术（ posterior chamber phakic implantable collamer lens surgery ,ICL）后眼前节参数变化及各参数与眼内压（ intraocular pressure , IOP）间相关性。方法：回顾性研究。2012／2014年于苏州理想眼科医院屈光手术中心行ICL患者43例74眼,应用Allegro Oculyzer眼前节诊断系统测量其术前、术后1、3、6 mo 前房容积（ anterior chamber volume , ACV ）、房角（ anterior chamber angle,ACA ）、中央前房深度（ central anterior chamber depth,ACD）、拱高（ vault）变化,并测量同一时期眼内压后进行统计学分析。结果：术前与术后1、3、6mo相比,术后较术前ACV,ACA, ACD均较显著减小（P＜0．01）。术后ACV,ACA,ACD在各随访观测时间点均稳定,术后vault 在1mo与6mo间存在统计学差异（ t＝27．66, P＝0．01）。而IOP术前与术后各测量点间无统计学差异（ P＞0．05）。各时期 IOP 与ACV,ACA,ACD,拱高均无显著相关性（P＞0．05）。结论：ICL术后眼前节参数ACV, ACA, ACD较术前均减小,术后早期即能达到稳定状态,眼内压具有同样的稳定性,且与 ACV, ACA, ACD, vault 变化无关,但仍需长期观测。     

两种不同手术矫治高度近视的对比研究

目的：比较有晶状体眼后房型人工晶状体(implantable contact lens,ICL)植入术与透明晶状体摘除术联合后房型人工晶状体植入术两种术式矫治高度近视的安全性、有效性及稳定性。

方法：选取高度近视患者56例100眼,分为两组：Ⅰ组ICL植入术组患者32例58眼,Ⅱ组透明晶状体摘除联合后房型人工晶状体植入术组患者24例42眼。手术前、后观察两组患者的视力、屈光度、眼压、角膜内皮细胞计数、前房深度、晶状体透明度、手术并发症及视觉不良症状。

结果：Ⅰ组和Ⅱ组术后3mo的裸眼视力>0.5者分别为69.0%和71.4%; 术后1a,裸眼视力>0.5分别为72.4%和73.8%。术后1a,Ⅰ组62.1%、Ⅱ组57.1%患者的屈光度在预期屈光度±1.0D之内; ICL光学部后表面与透明晶状体的距离0.35～0.54(平均0.40±0.16)mm; 术后一过性高眼压发生率：Ⅰ组为12.1%,Ⅱ组为7.1%; 角膜内皮细胞计数与术前相比,差异有统计学意义(P<0.001)。Ⅰ组其他手术并发症：ICL移位1眼,前囊下晶状体局限性混浊2眼,夜间出现眩光4眼。Ⅱ组后囊膜轻度混浊3眼,夜间出现眩光3眼,视近困难12眼。

结论：有晶状体眼后房型人工晶状体植入术与透明晶状体摘除术矫治高度近视具有较好的安全性、有效性和稳定性,但仍需长期随访,注意远期并发症的发生。     

Ultrasound biomicroscopy in patients with unilateral pseudoexfoliation

AIM: To compare the anterior segment morphology evaluated using ultrasound biomicroscopy (UBM) in patients with clinical pseudoexfoliation syndrome (XFS) in one eye and no clinical XFS in the fellow eye.METHODS: Thirty patients with unilateral XFS were included in the study. All patients underwent evaluation of their anterior segment using UBM with and without dilatation with 1% cyclopentolate. The anterior chamber depth (ACD), lens thickness (LT), anterior chamber angle (ACA), ciliary body thickness (CBT), scleral thickness (ST), trabeculae -ciliary processes distance (T-CPD), and iris-ciliary processes distance (I-CPD) were measured using UBM scans. All results between the eyes with clinical XFS and their fellow eyes without clinical XFS were then compared.RESULTS: Before dilatation the eyes with XFS (4.350±0.531 mm) were found to have a significantly thicker lens (P=0.002) than the eyes without XFS (4.238±0.540 mm). In addition after dilatation, the eyes with XFS (4.310±0.500 mm) were found to have a significantly thicker lens than the eyes without XFS (4.160±0.480 mm) (P=0.019). The average ACD, for the group with XFS, comparing pre-dilatation (2.616±0.349 mm) and post-dilatation measurements (2.714±0.413) was found to be statistically increased (P=0.014). The average ACD, comparing pre-dilatation to post-dilatation measurements in patients without XFS (2.680±0.360), (2.720±0.500) was found to be statistically unchanged (P=0.450).DISCUSSION: Crystalline lenses tended to be thicker in the eyes with clinical pseudoexfoliation than their fellow eyes without pseudoexfoliation.     

Pentacam与前节OCT测量有晶状体眼后房型人工晶状体植入术后拱高的比较

目的对有晶状体眼后房型人工晶状体（PPC-ICL）植入术后患者应用三维眼前节全景分析仪（Pentacam）与前节光学相干断层扫描仪（AS-OCT）测量拱高及其他眼前节参数,分析2种仪器的差异性和一致性。方法横断面研究。连续选取50例（100眼）PPC-ICL植入术术后复查患者,分别应用Pentacam和前节OCT测量眼前节参数。采用配对样本t检验及Bland-Altman图法对二者差异性和一致性进行统计学分析。结果Pentacam测得拱高值为（353.8±124.0）µm,前节OCT测得拱高值为（536.2±150.8）µm,两者差异有统计学意义（t=27.92,P＜0.05）,两者呈高度正相关性（r=0.905,P＜0.05）,Pentacam测得拱高比前节OCT测得拱高低（182.4±65.3）µm,其差值95%一致性区间为54.3～310.5 µm。结论Pentacam与前节OCT均能为我们提供拱高值,Pentacam测量值显著低于前节OCT测量值,在临床工作中应该综合分析。     

五种检查仪器对角膜水平直径测量的对比分析

目的：分析五种角膜直径测量方法对角膜水平直径测量的相关性和一致性。

方法：纳入2018-02/03在四川大学华西医院眼科行双眼ICL植入的患者25例50眼,术前分别采用规尺、眼前节分析系统SIRIUS、IOL Master500、眼前节OCT和UBM 5种方法测量角膜水平直径,比较5种方法测量结果的相关性及一致性。

结果：规尺、眼前节分析系统SIRIUS、IOL Master500、眼前节OCT和UBM测量的角膜水平直径分别为11.54±0.30、11.77±0.33、11.98±0.33、11.63±0.35、11.53±0.34mm(P<0.05),q检验结果显示规尺法与UBM法、眼前节OCT法,UBM法与眼前节OCT法测量的WTW值之间均无差异(P>0.05),直线相关分析发现五种检查方法测量值之间均具有显著相关性,Bland-Altman分析发现,规尺与SIRIUS、UBM、眼前节OCT检查值的95%LoA上下限绝对值均≤0.50mm。

结论：五种测量角膜水平直径的结果,规尺与SIRIUS,UBM和前节OCT的结果可以互换,其他结果不能互换。IOL Master500测量值最大,不宜作为测量角膜水平直径大小的诊断依据,其他测量设备检查结果应结合临床实践。     

应用Pentacam三维眼前段分析仪对虹膜夹型人工晶状体植入术后的研究

目的 应用Pentacam术后追踪测量虹膜夹型有晶状体眼人工晶状体(PIOL)中央和周边部与角膜内皮和自然晶体之间的距离,倾斜度、偏心值以及前房深度的变化,评价其在前房的位置.方法 收集自2006年1月以来接受虹膜夹型人晶状体植入术的22例33只眼.术后6个月全部患者行Pentacam检查,测量VRSM50和VRSM60两组不同类型虹膜夹型PIOL中央和周边部与角膜内皮和自然晶体之间的距离,并测量术后1d、1、3及6个月人工晶状体的偏心量、倾斜度及前房深度值.结果 角膜内皮至PIOL光学部前表面距离为(1.94±0.36)mm.PIOL后表面与自然晶状体间的距离为(0.76±0.12)mm.分别比较各组在不同时期的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).在术后1d、1、3及6个月,比较2组的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).结论 Pentacam三维眼前段分析仪为PIOL植入术后提供高质量的Scheimpflug摄像,可以为有晶状体眼前房型人工晶状体提供精确的眼内定位,在这一方面具有重要的临床应用价值.     

有晶状体眼后房型人工晶状体植入术后前房及前房角的超声活体显微镜观察

目的 应用超声活体显微镜(UBM)评价有晶状体眼后房型人工晶状体(ICL)植入术后前房及前房角的变化.方法 前瞻性系列病例研究.分析15例(30只眼)高度近视患者术前及ICL植入术后1周、1、3、6个月及1年的眼压变化;末次随访(术后1年)时行UBM检查,测最中央前房深度(ACD)、ICL后表面与晶状体之间的距离、小梁虹膜夹角,ICL周边部与晶状体之间的距离.小梁虹膜夹角比较则采用非参数检验;ICL周边部与晶状体之间的距离采用One-way ANOVA分析;术前术后各时间点的眼压比较采用重复测量方差分析和Bonferroni检验;中央ACD比较采用配对t检验.结果 术前眼压为(13.75±2.27)mm Hg(1 mm Hg=0.133 kPa),术后1周、1个月、3个月、6个月及1年时眼压分别为(14.27±1.70)mm Hg、(14.70±2.07)mm Hg、(14.07±2.24)mm Hg、(14.00±2.69)mm Hg和(13.97±2.95)mm Hg,术前及术后各次眼压间进行比较,发现仅术后1个月时眼压与术前、术后3个月时眼压比较差异有统计学意义(t=-3.706、3.898,P<0.05).UBM检查发现中央角膜内表面与晶状体之间的距离为(2.97±0.11)mm,中央角膜内表面与ICL之间的距离为(2.24±0.21)mm,两者之间差异有统计学意义(t=20.63,P<0.01).小梁虹膜夹角在钟表位12:00、3:00、6:00、9:00位差异无统计学意义,仅55.8%手术眼的小梁虹膜夹角>30°,ICL周边部与晶状体之间的距离在钟表位12:00、3:00、6:00、9:00位差异无统计学意义.ICL后表面与晶状体之间的距离为(0.63±0.16)mm,ICL与晶状体无接触.结论 ICL植入术后ICL位于晶状体前,致使术后中央ACD变浅、部分手术眼前房角宽度变窄.ICL与晶状体无接触,与虹膜后表面接触.     

Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT

AIM: To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS: This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS: There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION: Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.     

Effect of pupil size on posterior chamber phakic intraocular lens vault measurements

Purpose:The aim of this study was to measure the implantable collamer lens (ICL) vault changes with anterior segment optical coherence tomography (AS-OCT) after the implantation of the Visian posterior chamber phakic ICL with a central hole (V4c) in relation to the pupil size.Methods:This retrospective observational pilot study included 32 eyes of 16 patients, who underwent V4c ICL implantation. ICL vault was measured with AS-OCT in undilated and fully dilate state of the pupil. Primary outcome measure was the change in the vault of V4c ICL at the maximum and minimum pupil size.Results:Median (IQR) undilated and post-dilated vault measurement was 393.00 (335.50–493.50) microns and 421.00 (338.50–503.75) microns, respectively, which was not statistically significant (P = 0.44).Conclusion:No statistically significant difference was observed between the undilated and post-dilated ICL vault measurements. Hence, the postoperative vault can be measured either in resting, undilated state or fully dilated state of the pupil and would be similar irrespective of the pupil size.     

CASIA SS-1000眼前节OCT对初发期和膨胀期皮质性白内障患者晶状体厚度及前房结构测量的比较

背景 随着病情发展,皮质性白内障患眼的晶状体厚度及前房结构将发生变化,可能对眼部结构及功能产生重要影响,需要一种可直接测量晶状体前后表面及房角结构的检查方法,以量化不同分期白内障的上述指标变化. 目的 采用CASIA SS-1000眼前节光相干断层扫描(AS-OCT)测量并比较初发期和膨胀期白内障患者晶状体厚度及房角相关指标. 方法 采用观察性研究设计.连续纳入2015年10月16-30日于陆军军医大学大坪医院眼科门诊就诊的初发期和膨胀期皮质性白内障患者50例87眼,其中男21例,女29例;初发期白内障患者28例44眼,平均年龄(56.46±12.90)岁,膨胀期白内障患者22例43眼,平均年龄(70.95±8.81)岁.利用CASIA SS-1000 AS-OCT测量患眼晶状体厚度、房角开放距离(AOD)、前房角隐窝面积(ARA)、小梁网虹膜间面积(TISA)、小梁网虹膜角(TIA)及前房深度(ACD),比较2个组患眼相关指标的差异.结果 初发期白内障晶状体平均厚度为(4.438±0.487)mm,膨胀期白内障晶状体厚度平均为(5.094±0.451) mm,膨胀期白内障患眼晶状体明显增厚,平均增加(0.656±0.101) mm,差异有统计学意义(t=-6.513,P=0.000);初发期白内障患眼ACD平均为(2.966±0.326)mm,膨胀期患眼ACD平均为(2.534±0.376) mm,随着白内障发展,ACD平均减少(0.432±0.075)mm,差异有统计学意义(t=5.730,P=0.000).在房角相关测量指标中,膨胀期白内障患眼AOD500、AOD750、ARA500、ARA750、TISA500、TISA750、TIA500和TIA750明显低于初发期白内障患眼,差异均有统计学意义(均P=0.000).结论 膨胀期白内障患者晶状体厚度明显增加,前房变浅,房角明显变窄.CASIA SS-1000 AS-OCT测量房角扫描时间短,清晰度高,具有很好的临床应用前景.