Pentacam眼前节测量及分析系统的临床应用进展

Pentacam是第一台使用旋转Scheimpflug摄像机的眼前节测量及分析系统。它通过旋转测量,获取多重眼前节图像,产生三维立体图,计算眼前节的多个测量值,集角膜测厚、角膜前后表面地形测量、Scheimpflug图像显示、白内障分析和三维前房分析五种功能于一身。作为一种新的测量手段,Pentacam可广泛应用于屈光手术、青光眼、白内障、人工晶状体植入和圆锥角膜等临床研究和实践。     

试析10 MHzB超水浴法眼前节探查价

目的 探讨分析10MHzB超水浴法眼前节探查的价值.方法 以IOMHzB超分别采用水浴法和直接法对眼前节探查,并对声像图进行对比分析.结果 共探查261例(522只眼),10MHzB超水浴法探查发现异常57例(90只眼),其中晶状体混浊45例(78只眼);晶状体内异物1例(1只眼);晶状体半脱位1例(1只眼);人工晶状体半脱位2例(2只眼);晶状体后囊破裂2例(2只眼);睫状体脱离2例(2只眼);前房积血4例(4只眼).眼前节成像远离超声近场,无干扰及伪像,成像清晰.结论 水浴法探查拓展了10MHzB超的探查范围,使其前节观察成为可能,是一项具有临床实用价值的眼科超声检查方法.     

Pentacam眼前段成像系统的临床应用和相关研究

Pentacam 是第一台使用旋转Scheimpflug摄像机的眼前段测量及分析系统.它通过旋转测量,获取多重眼前段图像,产生三维立体图,计算眼前段的多个测量值,包括角膜厚度测量、角膜前后表面地形测量、Scheimpflug图像显示、白内障分析和三维前房分析等多种功能.可广泛应用于屈光手术、青光眼、白内障、人工晶状体植...     

Pentacam眼前段成像系统的临床应用和相关研究

Pentacam 是第一台使用旋转Scheimpflug摄像机的眼前段测量及分析系统.它通过旋转测量,获取多重眼前段图像,产生三维立体图,计算眼前段的多个测量值,包括角膜厚度测量、角膜前后表面地形测量、Scheimpflug图像显示、白内障分析和三维前房分析等多种功能.可广泛应用于屈光手术、青光眼、白内障、人工晶状体植入和圆锥角膜等临床研究和实践.近年,针对Pentacam和传统眼前段测量仪器的一致性进行了较多研究,并开拓和探索了新的结论和方法,使Pentacam应用前景更为广阔.     

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.     

人工晶体在前节OCT中的位移表现与伪调节力的研究

目的 分析人工晶状体植入后生理状态下,在眼内的前后位移度及其和伪凋节力的关系.方法 选择病人46例(46只眼)行白内障超声乳化联合单焦点一体式折叠人工晶状体植入术,检测和分析术后人工晶状体在眼前节OCT图像中的位移表现,记录不同度数镜片附加时的前房深度和瞳孔直径变化值,测量患者术眼的伪凋节力,并进行相关性分析.平均随访(5.2±1.6)个月.结果 78.26%(36/46)术眼屈光矫正后近视力≥Jr5;患者术眼术后平均伪凋节力为(1.08±0.71)D.眼前节OCT图像显示附加负值镜片时人工晶状体向前位移,前房变浅,附加正值镜片时人工晶状体向后位移,前房变深,前房深度变化值为(0.26±0.09)mm;不同度数镜片附加时瞳孔直径变化值为(0.58±0.28)mm.伪凋节力与前房深度变化呈正相关(r=0.8267,P＜0.01),与瞳孔直径变化亦呈正相关(r=0.6724,P＜0.01).结论 白内障术后人工晶状体在生理状态下位置可前后移动,视近时睫状肌收缩、人工晶状体向前移动,是IOL眼产生伪凋节力的重要机制之一;瞳孔收缩也可部分补偿调节力.     

Pentacam三维前房分析仪在眼科应用前景乐观

德国北京欧德傲科(Oculus)公司出产的Pentacam三维前房分析仪是全世界第一台应用Scheimpflug光学原理进行断层扫描、三维测量的眼科仪器(图1)。普通照像的景深非常有限，Scheimpflug照像的优点为聚焦景深大，图像清晰。该仪器1秒钟可扫描25条线，测量并分析至少25000个点，以确保图像和分析的精准。Pentacam图象可完整地三维重建眼前节结构，对角膜、前房、虹膜、     

马凡综合征晶状体半脱位超声生物显微镜检查特点

目的：应用超声生物显微镜（ UBM）观察马凡综合征的眼前节改变特点。方法对已确诊为马凡综合征者进行UBM检查,观察眼前节的结构改变。结果4例（8只眼）晶状体全部半脱位,2只眼偏向鼻侧,6只眼偏向鼻上方。虹膜根部附着偏前;睫状体变薄,睫状突不明显。结论马凡综合征具有明显的眼前节改变,UBM是一种有价值的辅助检查,能较好地显示晶状体半脱位情况及睫状体形态改变。     

Pentacam眼前节分析系统在激光周边虹膜切除术前后眼前节结构评估中的应用

目的 评价Pentacam 眼前节分析系统的临床应用价值.方法 自身对照研究.33例(61只眼)原发性闭角型青光眼和原发性房角关闭患者,在接受掺钕钇铝石榴石激光周边虹膜切除术前及术后,应用Pentacam眼前节分析系统进行眼前节摄像和图像分析,同时分别测定患者眼前房相关量化指标.激光周边虹膜切除术前后各检测参数的变化比较采用配对t检验.结果 Pentacam眼前节分析系统能够清晰显示激光治疗前后眼前节结构变化,如虹膜变平坦及周边前房加深.患者术后平均眼前房容积(94.10±18.42)mm3(t=-15.928);最小前房角(24.93±4.53).(t=-5.087);周边前房深度:颞侧(1.23±0.23)mm(t=-17.399),上方(1.03±0.20)mm(t=-10.629),鼻侧(0.99±0.21)mm(t=-12.576),下方(1.16±0.24)mm(t=-14.474);上述参数与术前比较均明显增加,差异有统计学意义(均P＜0.01).其中前房容积从术前的(74.10±16.35)mm3增加到术后的(94.10±18.42)mm3,周边前房深度的增加幅度为0.17 mm(鼻侧)至0.29 mm(颞侧);而中央前房深度较术前无明显增加.结论 Pentacam眼前节分析系统可定性和定量反映原发性闭角型青光眼和原发性房角关闭眼激光周边虹膜切除术后前房形态和参数的变化.     

Pentacam测量近视眼角膜厚度和前房深度

目的:比较Pentacam三维眼前节分析仪测量中央角膜厚度、前房深度与A型超声测量的差异,以评价Pentacam在眼前节参数测量中的准确性。方法:分别使用Pentacam眼前节分析仪和A型超声角膜测厚仪测量82例164眼近视患者的中央角膜厚度和前房深度,对两种方法的测量结果进行比较,并与眼压及眼轴长度进行了相关分析。结果:Pentacam眼前节分析仪测得中央角膜厚度和前房深度分别为524±0.037μm,3.26±0.25mm。A型超声角膜测厚仪测得值分别为521±0.036μm,3.36±0.53mm。两种测量结果比较中央角膜厚度和前房深度差异均有统计学意义(P<0.01,P<0.05)。光学法测量的中央角膜厚度值较超声法平均大3μm。超声法所测前房深度值较光学法平均大0.1mm。两种方法测量的角膜厚度与眼压及前房深度与眼轴长度均呈正相关(P<0.01)。结论:Pentacam三维眼前节分析仪测量屈光不正患者的中央角膜厚度和前房深度与A型超声测量结果存在一定差异。     

应用Pentacam三维眼前节分析仪评价玻璃体切割联合白内障超声乳化术后人工晶状体在眼内的稳定性

目的采用Pentacam三维眼前节分析仪研究玻璃体切割联合白内障超声乳化术后前房深度（ACD）、人工晶状体（IOL）倾斜度及偏心度的变化情况,及不同玻璃体腔填充物对IOL在眼内稳定性的影响。方法采用临床前瞻性研究,对玻璃体视网膜疾病合并白内障患者42例46眼行1期玻璃体切割联合白内障超声乳化IOL（AcrySofSA60）植入术,根据眼底情况选择灌注液、惰性气体及硅油填充,采用Pentacam三维眼前节分析仪测量术后1周、1个月、3个月IOL的位置。结果手术前后不同时间点间ACD值的差异有统计学意义（F=64.239,P=0.000）,术后各时间点ACD值均较术前增加（P〈0.05）,但术后3个月达到稳定。术后不同时间点间IOL偏心度差异有统计学意义（F=26.459,P=0.000）,术后3个月硅油填充组与术后1周、1个月相比IOL偏心量均明显增加（P〈0.05）;不同玻璃体填充物组IOL偏心量的差异无统计学意义（F=2.282,P=0.114）。在术后各个随访时间点,IOL倾斜度的差异无统计学意义（F=0.977,P=0.401）,不同玻璃体填充物组的IOL倾斜度差异无统计学意义（F=1.413,P=0.254）。结论 Pentacam三维眼前节分析仪可动态观察并评价IOL在眼内的稳定性;惰性气体填充对眼内IOL的影响较灌注液填充和硅油填充明显,但总体而言各种玻璃体腔填充眼术后IOL在眼内的位置基本稳定。     

Optical coherence tomography assessment of angle anatomy changes after cataract surgery

PURPOSE: To evaluate changes in anterior chamber (AC) morphology induced by cataract extraction using anterior segment optical coherence tomography (OCT). DESIGN: Prospective comparative observational case series. METHODS: Thirty-two eyes of 32 patients underwent OCT imaging of the angle before and after cataract surgery. Anterior chamber depth (ACD), angle opening distance at 500 microm (AOD(500)) and trabecular-iris space at 500 microm (TISA(500)) were measured pre- and postoperatively. Preoperative lens thickness (LT) and lens position (LP) were calculated. RESULTS: ACD, AOD(500), and TISA(500) increased significantly after cataract extraction (P < .001). Preoperatively, ACD and LT highly correlated (P = .0083) as did ACD and TISA(500) (P = .0001). TISA(500) correlated with LP (P = .0001) but not with LT (P = .74). CONCLUSIONS: Changes in angle morphology after cataract surgery can be imaged and objectively quantified by anterior segment OCT. Lens position may have a greater influence on angle width than LT.     

应用PENTACAM三维眼前段分析仪对人工晶状体在眼内稳定性的研究

目的:采用PENTACAM三维眼前段分析仪研究3种类型人工晶状体在眼内的倾斜度数、偏心值以及前房深度的变化情况,评价其在眼内的稳定性。方法:采用临床随机前瞻性研究,对109例(117只眼)老年性白内障患者行超声乳化白内障吸除术,随机植入一片式AcrysofSA60AT、三片式TecnisZ9001或SensarAR40e人工晶状体,采用PENTACAM三维眼前段分析仪测量三组术后1d、1、3、6及12个月人工晶状体的偏心量、倾斜度及前房深度值。结果:分别比较各组在不同时期的平均偏心量与平均倾斜度,差异均无统计学意义(P>0.05)。在术后1d、1、3、6及12个月,分别比较3组的平均偏心量与平均倾斜度,差异均无统计学意义(P>0.05)。一片式AcrysofSA60AT组在不同时期的前房深度变化不大,差异无统计学意义(P>0.05);而三片式TecnisZ9001及SensarAR40e组术后第1天的前房深度大于术后其它时期,也大于一片式AcrysofSA60AT组术后不同时期的值,差异有统计学意义(P<0.05)。结论:PENTACAM三维眼前段分析仪可动态客观地评价人工晶状体在眼内的稳定性;适当的连续环形撕囊和准确的囊袋内固定能很好地维持折叠式人工晶状体在眼内的稳定性,且AcrysofSA60AT一片式软性襻人工晶状体的囊袋稳定性略优于三片式硬性襻人工晶状体。     

不同手术方法治疗闭角型青光眼合并短眼轴的对比观察

目的:比较单纯小梁切除术和小梁切除术联合白内障超声乳化联合人工晶状体植入术(以下简称三联术)治疗闭角型青光眼合并短眼轴的疗效。方法:回顾分析2005-07/2009-01收住我院的闭角型青光眼合并短眼轴患者31例39眼。行单纯小梁切除术者25眼,行三联术者14眼。术后随访1～25(平均9.51±6.11)mo。结果:术后眼压:三联术者术后眼压平均(11.31±0.69)mmHg,手术前后有显著统计学差异(P<0.01);小梁切除术者术后平均(18.47±3.54)mmHg,手术前后差异有统计学意义(P<0.05);最佳矫正视力:三联术者术后均提高,≥0.3者占78%,小梁切除术者术后5眼视力不增反降,≥0.3者占32%,两者差异有显著性;UBM(超生生物显微镜)检查:小梁虹膜角(TIA)三联术者手术前后差异有显著性,小梁切除术者手术前后无显著性差异;中央前房深度(ACD):三联术术后平均为(3.22±0.53)mm,手术前后有显著性差异(P<0.01),小梁切除术后平均为(2.21±0.41)mm,比较差异无显著性;术后并发症:三联术术后并发症少,且均无需再手术纠正,小梁切除术者术后并发症较多,部分严重且持久,需再次手术。结论:小梁切除术联合白内障超声乳化联合人工晶状体植入术治疗闭角型青光眼合并短眼轴较单纯小梁切除术设计更合理,手术成功率高,疗效好,并发症少。     

白内障手术对滤过术后的原发性闭角型青光眼前房深度和晶状体位置的影响

目的比较滤过术后晶状体混浊的原发性闭角型青光眼(PACG)与单纯老年性白内障患者超声乳化白内障吸出联合人工晶状体(IOL)植入术手术前后前房深度和晶状体位置的改变。设计比较性病例系列。研究对象小梁切除术后具有功能性滤过泡且未用药下眼压≤21 mm Hg的PACG患者16例(16眼)及年龄、性别匹配的单纯老年性白内障患者17例(17眼)。方法在超声乳化白内障吸出联合IOL植入术前及术后1周行眼前段相干光断层扫描(AS-OCT),比较PACG组和对照组手术前后的前房深度和晶状体位置参数。主要指标中央前房深度(ACD)、前房宽度(ACW)、晶状体厚度(LT)和晶状体矢高(CLR)。结果术前PACG组的ACD(1.74±0.33)mm较正常对照组(2.67±0.21)mm浅(t=-5.961,P=0.00),LT(5.38±0.44)mm和CLR(0.98±0.46)mm较正常对照组(分别为4.72±0.25 mm和0.51±0.17 mm)大(t=-3.707、3.028,P=0.00和0.04),两组间ACW比较无统计学差异(t=1.608,P=0.09);术后两组间的ACD(3.32±0.20 mm vs.3.65±0.40 mm)、ACW(11.12±0.42 mm vs.11.30±0.25 mm)和CLR(-0.60±0.14 mmvs.-0.56±0.29 mm)比较均无统计学差异(P均>0.05);手术后两组间ACD的平均增加值(1.58 mm vs.0.98 mm),CLR的平均减少值(1.58 mm vs.1.06 mm)有统计学差异(t=0.771、0.236,P=0.04、0.00)。结论滤过术后的PACG患者前房深度仍比正常人浅,晶状体较厚且位置靠前;行超声乳化吸出联合IOL植入术后可明显加深前房深度、改善前房拥挤的现象。     

高度近视眼透明晶状体置换手术后眼前节结构变化的临床观察

目的:通过超声生物显微镜观察高度近视眼透明晶状体置换手术后眼前节结构的变化。方法:对20例36眼以矫正高度近视为目的高度近视患者,行透明晶状体超声乳化吸除联合折叠式人工晶状体植入手术。术前和术后1mo分别应用超声生物显微镜(ultrasound biomicroscopy,UBM)测量前房深度(anterior chamber depth,ACD)、前房角开放距离(angle opening distance,AOD)和前房角开放度数(anterior angle,AA)。结果:患者术后1mo的ACD,AOD,AA与术前相比有显著性差异(P=0.000),术后房角宽度、前房深度明显大于术前;眼轴与术后、术前前房深度的差值呈负相关(r=-0.711,P=0.000)。结论:高度近视患者行超声乳化透明晶状体吸除联合折叠式人工晶状体植入术,术后前房加深,房角增宽,眼轴与术后、术前前房深度的差值呈负相关。     

前房深度对人工晶状体位置影响的研究

目的:探讨前房深度对人工晶状体位置的影响。方法:回顾性研究。收集广州爱尔眼科医院2018年1月至12月行飞秒激光辅助白内障超声乳化人工晶状体植入术119例(134眼)的临床资料。据术前前房深度,本组患者分成3组：浅前房组(A组),48例(55眼),前房深度<2.5 mm;正常前房深度组(B组),50例(52眼),前房深...     

Lens opacity, thickness, and position in subjects with acute primary angle closure

PURPOSE: To compare lens thickness (LT), lens position (LP), relative lens position (RLP), and degree and type of lens opacity between affected and fellow eyes of subjects with acute primary angle closure (APAC) to identify any differences in lens characteristics that may be contributory to the acute episode. In addition, axial length (AL) and anterior chamber depth (ACD) measurements were evaluated. METHODS: Seventy-three study subjects with unilateral APAC were treated with sequential laser iridotomy (LI) in both eyes. Two weeks after LI, ACD, LT, and AL measurements were made in both eyes using ultrasound pachymetry. LP was defined as ACD+1/2LT and RLP as LP/AL. The Lens Opacity Classification III (LOCS III) System was used for grading lens opacity. RESULTS: The subjects were 90% Chinese and 63% female. Mean age was 61.0+/-10.9 years. Significant differences between the affected and fellow eyes were found in the ACD (2.11+/-0.35 vs 2.18+/-0.23; P=0.02) and LP (4.61+/-0.47 vs 4.75+/-0.29; P=0.02). Cortical opacity was greater in fellow eyes (0.32+/-0.72 vs 0.53+/-0.95; P=0.02). There was no difference in LT, RLP, or degree of lens opacity in the nuclear and posterior subcapsular regions. CONCLUSIONS: Compared with fellow eyes, APAC-affected eyes have shallower ACD, more anterior LP, and less cortical opacity. These differences may be contributory to APAC.     

Comparison of anterior section parameters using anterior segment optical coherence tomography and ultrasound biomicroscopy in myopic patients after ICL implantation

AIM: To compare the agreement of anterior chamber depth (ACD) and central vault measurements obtained by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) of post surgical high myopic eyes with posterior chamber phakic intraocular lens (Visian ICL; STAAR Surgical) implantation. METHODS: Fifty-two phakic eyes of 28 high myopic patients who underwent implantable Collamer lens (ICL) surgery for the correction of high myopia were studied. The postoperative ACD, the distance between the corneal endothelium and the anterior surface of ICL (cornea-ICL) and the central vault were measured with the AS-OCT system and the UBM system. Intraclass correlation coefficient (ICC) and the Bland-Altman plot were used to evaluate the repeatability and agreement of two devices. RESULTS: The mean ACD, cornea-ICL and central vault in the 52 phakic eyes after ICL surgery was 3.19±0.28 mm, 2.47±0.28 mm, 0.50±0.19 mm by AS-OCT and 3.13±0.25 mm, 2.49±0.25 mm, 0.44±0.19 mm by UBM, respectively. Pairwise comparison of ACD and central vault measurements showed significant differences between AS-OCT and UBM (P<0.05). However, no statistically significant difference was found between these imaging techniques in cornea-ICL (P>0.05). The Pearson correlation coefficient (r) between AS-OCT and UBM measurements for ACD, cornea-ICL and vault was 0.88, 0.80 and 0.89, respectively (P<0.001). The ICC was 0.89-0.94 for the measurements of AS-OCT and UBM. Bland-Altman analysis showed the 95% limits of agreement of ACD, cornea-ICL, central vault measurements between these two devices were -0.20 to 0.32 mm, -0.36 to 0.32 mm and -0.12 to 0.24 mm, respectively. CONCLUSION: Central ACD and vault measurements using AS-OCT demonstrated a slight significantly higher value than using UBM in phakic eyes after ICL surgery. These two devices should not be used interchangeably for measurements of central ACD and vault in patients after phakic intraocular lens implantation.     

Anterior chamber configuration changes after cataract surgery in eyes with glaucoma

Purpose

To evaluate changes in anterior chamber depth (ACD) and angle width induced by phacoemulsification and intraocular lens (IOL) implantation in eyes with glaucoma, using anterior segment optical coherence tomography (AS-OCT).

Methods

Eleven eyes of 11 patients with angle-closure glaucoma (ACG) and 12 eyes of 12 patients with open-angle glaucoma (OAG) underwent phacoemulsification and IOL implantation. Using AS-OCT, ACD and angle parameters were measured before and 2 days after surgery. Change in intraocular pressure (IOP) and number of ocular hypotensive drugs were evaluated.

Results

After surgery, central ACD and angle parameters increased significantly in eyes with glaucoma (p < 0.05). Prior to surgery, mean central ACD in the ACG group was approximately 1.0 mm smaller than that in the OAG group (p < 0.001). Post surgery, mean ACD of the ACG group was still significantly smaller than that of the OAG group. No significant differences were found in angle parameters between the ACG and OAG groups. In the ACG group, postoperative IOP at the final visit was significantly lower than preoperative IOP (p = 0.018) and there was no significant change in the number of ocular hypotensive medications used, although clinically, patients required fewer medications. In the OAG group, the IOP and number of ocular hypotensive drugs were almost unchanged after surgery.

Conclusions

The ACD and angle width in eyes with glaucoma increased significantly after phacoemulsification and IOL implantation. Postoperative ACD significantly differed between the ACG and OAG groups, whereas angle parameters did not differ.