IOLMaster与A型超声校正法测量硅油眼眼轴的对照研究

背景白内障摘出联合人工晶状体（IOL）植入术是提高患者生活质量的方法,但传统的硅油眼IOL度数的测量往往较实际的度数偏大。光学相干生物测量技术已被广泛用于IOL度数的测量,但需要探求其所测IOL度数与实际值的差别。目的探讨并比较IOLMaster及眼部A型超声生物测量校正方法测量硅油填充眼眼轴的准确性,以及2种测量方法在计算IOL度数方面的差别。方法42例44只硅油填充眼按眼压不同分为≥10mmHg组29眼和〈10mmHg组15眼,分别用IOLMaster和眼部A型超声测量校正2种方法在硅油取出术前和术后测量眼轴,利用术前测量的眼轴及角膜曲率推算理论IOL度数,评价IOLMaster测量硅油填充眼眼轴的优点及其预测IOL度数的临床意义。结果对于眼压≥10mmHg的硅油填充眼,IOLMaster测量法与A型超声校正法所得眼轴数值之间差异有统计学意义（P=0．015）,但硅油取出术后与术前眼轴差异无统计学意义（P=0．10）,IOLMaster测量硅油眼眼轴的误差值均低于A型超声法,差异有统计学意义（ZMIOLMaster参照=一2．236,P=0．025）,而且关于预测的IOL度数误差,IOLMaster测量法也小于A型超声校正法;对于〈10mmHg的硅油填充眼,IOLMaster和A型超声校正法在硅油取出术后所测的眼轴和IOL度数均明显低于硅油取出前所测值,差异均有统计学意义（P=0．006）。结论眼压稳定、眼底情况较好的硅油眼行硅油取出联合IOL植入术前采用IOLMaster测量法预测IOL度数的准确性和稳定性优于A型超声校正法,但对于术前眼底情况复杂、手术次数多、眼压不稳定的硅油眼,2种方法均无法准确预测术后眼轴及IOL度数,建议硅油取出后再行IOL植入术。     

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.     

高度近视孔源性视网膜脱离行玻璃体切割联合晶状体手术后屈光状态的变化

目的　观察高度近视孔源性视网膜脱离（rhegmatogenous retinal detachment,RRD）患者行玻璃体切割联合晶状体手术后屈光状态的变化。方法　回顾性分析2016年1月至2017年3月于青岛大学附属医院确诊为RRD的患者30例30眼的临床病例资料。高度近视组15例15眼,非高度近视组15例15眼。两组患者均先行玻璃体切割联合白内障超声乳化吸出术并填充硅油,3个月后均行硅油取出联合人工晶状体（intraocular lens,IOL）植入术。IOL植入术后随访6个月。两组玻璃体切割术前均测量眼轴长度、角膜曲率,根据这两项指标计算IOL植入后的预测屈光度。硅油取出结合IOL植入术后1个月、3个月、6个月复测眼轴长度、角膜曲率、验光计算实际屈光度数（实际屈光度）。两组手术前后均测量最佳矫正视力并计算LogMAR视力。观察两组手术前后LogMAR视力、屈光度、眼轴长度、角膜曲率的变化,分析高度近视组术后屈光预测误差与术前眼轴长度之间的关系。结果　术后两组视力均较术前提高,差异均有统计学意义（均为P＜0.05）。高度近视组术后1个月、3个月、6个月屈光较术前均向近视方向漂移,随时间变化近视漂移逐渐增大,术后各时间点相比差异均有统计学意义（均为P＜0.05）;非高度近视组术后各时间点屈光较术前及术后各时间点屈光相比差异均无统计学意义（均为P＞0.05）。高度近视组术后1个月、3个月、6个月眼轴长度、角膜曲率较术前均明显提高（均为P＜0.05）;非高度近视组术后1个月、3个月、6个月眼轴长度、角膜曲率较术前均无明显变化,差异均无统计学意义（均为P＞0.05）。高度近视组术后6个月屈光预测误差与术前眼轴长度之间呈负相关（R²=0.580,P=0.001）。结论　RRD患者行玻璃切割联合晶状体术后最佳矫正视力提高,高度近视患者术后屈光向近视方向漂移,且随着术后时间的延长屈光向近视方向漂移更明显;高度近视患者术后眼轴增长,角膜曲率增大,高度近视患者术前眼轴越长,术后屈光越向近视方向漂移。     

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。     

人工晶状体屈光度IOL Master测算的精确度

目的全面客观地评价IOL Master计算人工晶状体屈光度的精确度。方法121例(154眼)老年性白内障,术前分别应用IOL Master和眼科传统设备两种方法测量眼部参数并计算所需人工晶状体的屈光度,术后检查术眼屈光误差。结果眼轴长度方面:短眼轴和正常眼轴组中两种设备测得的值差异有统计学意义(P<0.001);前房深度方面:正常眼轴和长眼轴组中两种设备测得的值差异有统汁学意义(P=0.001);屈光误差方面:IOL Master法在各公式中的误差均小于传统的A超法。误差≤1D的比例高于传统的A超法。结论IOL Master测量并计算人工晶状体屈光度的精确度高于传统的方法。     

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。     

硅油填充眼眼轴的A型超声测量

目的 评价修改相应参数后A型超声直接测量硅油填充眼眼轴长度的临床应用效果。方法 将超声波在玻璃体中的传播速度1532m／s改设为在硅油中的传播速度987m／s后，对11例有晶状体硅油填充眼，按A型超声其他默认参数，在“Phakic、Auto＋Save”模式下自动测得眼轴长；13例无晶状体硅油填充眼，在“Aphakic、Manual”模式下，手动测得眼轴长。取平均值，用SRK-T公式计算出IOL度数。硅油取出联合IOL植入术后3个月，在“Acrylic、Auto＋Save”模式下，按A型超声其他默认参数，自动测量眼轴；并测定术后屈光度。结果11例有晶状体硅油填充眼术前眼轴测量值23．94～28．68（平均25．74±1．65）mm；实际眼轴值23．60～28．94（平均25．68±1．73）mm。实际眼轴与术前测量值的差值为-0．51～0．36（平均-0．06±0．30）mm，二者间差异，无统计学意义。13例无晶状体硅油填充眼术前眼轴测量值23．86～28．70（平均25．89±1．50）mm；实际眼轴值23．92～28．52（平均25．82±1．38）mm。实际眼轴与术前测量值的差值为-0．45～0．54（平均-0．07±0．29）mm，二者间差异，无统计学意义。硅油取出联合IOL植入术后，两组屈光度分别为-1．25～1．75（平均-0．07±1．09）D、-2．00～2．25（平均0．31±1．35）D；二者间差异，无统计学意义。结论将超声波在玻璃体中的传播速度改设为在硅油中的传播速度后，再按A型超声其他默认参数，有晶状体眼在。Phakic、Auto＋Save”模式下自动测量、无晶状体眼在“Aphakic、Manual”模式下手动测量，是获得硅油填充眼眼轴值较为准确、快速、实用、价廉的方法，值得推广应用。     

黄斑前膜合并白内障患者白内障超声乳化人工晶状体植入联合玻璃体切割术前后屈光状态改变

背景 特发性黄斑前膜（IMEM）合并年龄相关性白内障（ARC）是老年人常见的眼部疾病,其主要治疗方法为白内障超声乳化人工晶状体（IOL）植入联合玻璃体切割术,而确定术前计算IOL屈光度时所用的IOL Master光学生物测量仪测量的眼轴长度是否受黄斑前膜的影响对术眼术后获得准确的屈光度至关重要.目的 了解IMEM患者行白内障联合玻璃体手术后屈光变化的特征.方法 采用前瞻性队列研究设计,纳入2010年9月至2011年8月在北京大学人民医院眼科中心确诊为IMEM合并ARC的患者42例42眼为IMEM合并ARC组,行白内障超声乳化IOL植入术联合玻璃体切割术,同期纳入单纯ARC患者47例47眼为单纯ARC组,行白内障超声乳化IOL植入术.术前应用IOL Master光学生物测量仪测量术眼眼轴长度及角膜曲率,应用SRK-T公式计算出IOL植入后的预期屈光度.术后1个月、3个月进行眼科常规检查和医学验光,计算其等效球镜度数作为术后实际屈光度,并对术后实际屈光度与预期屈光度进行对比分析.对两个组间术眼手术前后屈光度的误差进行比较,对IMEM合并ARC患者术后屈光度误差与黄斑中心凹厚度变化的关系进行分析.结果 术前两个组间患者年龄、眼轴长度和角膜曲率的差异均无统计学意义（P=0.863、0.704、0.770）.IMEM合并ARC组和单纯ARC组患者术后3个月视力较术前均明显改善,差异均有统计学意义（P=0.001、0.000）.IMEM合并ARC组患者术后1个月和3个月的实际屈光度绝对值均明显高于术前预期屈光度绝对值,差异均有统计学意义（P＜0.001）;单纯ARC组患者术后1个月和3个月实际屈光度绝对值明显高于术前预期屈光度绝对值,差异均有统计学意义（p＜0.O01）;但IMEM合并ARC组与单纯ARC组间手术前后的屈光度值差异无统计学意义（F分组=0.417,P=0.520）.IMEM合并ARC组术眼术后1个月、3个月的屈光度误差分别为（-0.727±0.666     

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.     

白内障术前测算人工晶状体屈光度不同方法的对比研究

目的对比研究光学低相干反射生物测量仪（Lenstar LS900）、光学相干生物测量仪（IOL Master）及A型超声扫描3种方法测量眼轴、前房深度及计算所需IOL屈光度,比较3种方法所测数据之间的差异。方法应用LenstarLS900、IOLMaster及A型超声扫描仪分别对50例（80眼）白内障患眼进行眼轴及前房深度测量;利用3种设备分别计算所需IOL屈光度,均选用SRK／T计算公式和SA60AT（Alcon）人工晶状体,在确定同一度数的前提下比较目标屈光度的差异。结果Len-star LS900、IOL Master及A超测量眼轴长度及前房深度,三者所测的数据之间差异无统计学意义,具有良好的相关性。Lenstar LS900和IOL Master所获得的术后目标值差异无统计学意义（P〉0．05）,而B超所获得的术后目标值与另二者获得的结果差异有统计学意义（P〈0．05）。Bland—Ahman分析显示,3种设备获得的目标屈光值具有良好的一致性,尤其是Lenstar LS900和IOL Master之间。结论在白内障患眼的生物测量中,Lenstar LS900、IOL Master和A超有良好的一致性。同时,Lenstar LS900还可以快速、准确的为白内障和屈光医生提供更多眼生物信息。     

IOL-Master测量有晶状体眼前房型人工晶状体度数的临床评估

目的 通过比较光学相干生物测量仪(IOL-Master)与传统公式对有晶状体眼前房型人工晶状体度数预测的准确性,评价IOL-Master的临床应用价值.方法 对高度近视患者17例(24只眼)行有晶体眼前房型人工晶状体植入术,分别按照Holladay公式和IOL-Master提供的公式得出的人工晶状体度数植入前房型人工晶状体(PACLs),记录术后6个月患者视力及眼屈光度和平均绝对屈光误差值(MAIZE).结果 患者术后裸眼远、近视力与最佳矫正视力均达到或高于术前最佳矫正视力,屈光状态明显改善,且差异具有统计学意义(P<0.05).两组术后MAIZE均达到理想状态,其中MAFE≤±0.5D:A组7只眼(77.8%),B组12只眼(80%);MAFE≤±1.0D:A组8只眼(88.9%),B组14只眼(93.3%),两组差异在统计学上没有显著性差异.结论 IOL-Master提供的有晶状体眼前房型人工晶状体度数的测量方法方便、快捷,效果可靠,可以在临床中进一步应用.     

无晶状体眼患儿的眼轴测量方法

目的:比较CarlZeiss IOL-Master与传统生物测量方法在测量无晶状体眼患儿眼轴长度的准确性。方法:术前分别应用传统超声生物测量方法,自动电脑验光仪及IOL-Master测量眼轴长度及角膜曲率。按超声方法测量结果计算植入人工晶状体的屈光度。利用IOL-Master测量结果计算其预测屈光误差。术后1mo检查患者的屈光状态。结果:当眼轴≤26mm时,IOL-Master测得的眼轴均值为(23.28±0.63)mm,接触式A超测量的眼轴均值为(23.24±0.64)mm,两者之间比较差异无显著性意义。当眼轴>26mm时,IOL-Master测得的眼轴均值为(26.48±0.35)mm,接触式A超测量的眼轴均值为(26.68±0.38)mm,两者之间比较差异有显著性意义(P<0.01)。IOL-Master测得的角膜曲率为(44.42±1.18)D,自动验光仪测得的角膜曲率为(44.40±1.25)D,两者之间比较差异无显著性意义。当眼轴≤26mm时,术后实际屈光度为(-0.28±0.36)D,IOL-Master组预计术后屈光度为(-0.39±0.53)D,传统生物测量方法组预计术后屈光度(-0.25±0.15)D,各组之间比较差异无显著性意义。当眼轴>26mm时,术后实际屈光度为(0.38±0.18)D,IOL-Master组预计术后屈光度为(0.43±0.24)D,传统生物测量方法组预计术后屈光度为(-0.05±0.07)D,实际屈光度与IOL-Master预计术后屈光度两者之间比较差异无显著性意义,实际屈光度与传统生物测量方法组的预计术后屈光度两者之间比较差异有显著性意义(P<0.01)。结论:无晶状体眼患儿进行眼轴测量时,IOL-Master有非接触、高准确、操作简便等优点,另外对无晶状体眼的高度近视患儿IOL-Master测量的准确性高,在一些特殊情况仍需依赖于传统接触式A超测量。     

Clear lens extraction with intraocular lens implantation during retinal detachment repair in patients with Acquired Immune Deficiency Syndrome (AIDS) [correction of autoimmune deficiency syndrome] and cytomegalovirus retinitis

OBJECTIVE: To assess the outcomes of clear lens extraction with intraocular lens (IOL) implantation during repair of retinal detachment by vitrectomy with silicone oil tamponade in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twelve eyes of 10 patients with AIDS, CMV retinitis, and retinal detachment. INTERVENTION: All patients underwent phacoemulsification with posterior chamber IOL placement at the time of vitrectomy with silicone oil tamponade for repair of retinal detachment. A targeted postoperative refractive error of -5.00 diopters (D) to -3.00 D was chosen in an attempt to counteract the hyperopic effect of silicone oil. MAIN OUTCOME MEASURES: The following factors were evaluated: postoperative visual acuity, refractive error, and intraoperative and postoperative complications. RESULTS: Median follow-up was 7 months (range, 1-46 months). For patients without macular necrosis, median best-corrected preoperative visual acuity was 20/75 (range, 20/20-20/800), and median best postoperative visual acuity was 20/50 (range, 20/20-20/400). Median final visual acuity was 20/140 (range, 20/25 to count fingers at 1 foot). The median postoperative refractive error (spherical equivalent) was -1.00 D (range, -4.00 D to +7.88 D). Reoperation was required in 3 of 12 eyes for recurrent macular detachment (1 with silicone oil underfill; 2 with proliferative vitreoretinopathy). The macula was attached in all eyes at last follow-up. Reattachment of the peripheral retina was achieved in 10 of 12 eyes. There were no anterior segment complications. CONCLUSIONS: Clear lens extraction with IOL placement during repair of retinal detachment with silicone oil tamponade does not seem to increase complications and may improve long-term visual rehabilitation, improve retinitis management by allowing better posterior segment visualization throughout the postoperative course, and decrease overall cost and morbidity associated with cataract extraction as a second procedure.     

硅油填充眼在不同时机行人工晶状体植入的屈光误差比较

目的:比较玻璃体切割硅油填充眼不同时机行白内障超声乳化并人工晶状体植入术后屈光误差。方法:回顾性分析选取2009-01/2011-12玻璃体切割硅油填充眼不同时机行白内障超声乳化并人工晶状体植入术51例51眼,其中A组17例行玻璃体切割硅油填充联合白内障超声乳化并人工晶状体植入术,术后3～6mo行硅油取出;B组13例行玻璃体切割术后硅油取出联合白内障超声乳化并人工晶状体植入术,C组21例硅油取出术后择期行白内障超声乳化并人工晶状体植入术,比较术后3mo时屈光误差情况。结果:三组平均绝对屈光误差值分别为(0.873±0.256)D,(0.828±0.134)D,(0.473±0.121)D,A组和B组之间差异无统计学意义(P>0.05),C组和A组及B组之间差异有统计学意义(P<0.05)。结论:A超眼轴测量计算人工晶状体度数,玻璃体切割硅油填充眼在取油后择期行白内障超声乳化并人工晶状体植入术屈光误差小。     

IOL-Master在OxaneHD填充眼眼轴测量中的应用

目的　分析应用ＩＯＬ-Ｍａｓｔｅｒ测量重硅油ＯｘａｎｅＨＤ填充眼眼轴长度的效果。方法　收集２０１１年５月至２０１３年５月在我院就诊的３６例（３６眼）重硅油ＯｘａｎｅＨＤ填充眼患者,分别应用Ａ超和ＩＯＬ-Ｍａｓｔｅｒ进行眼轴测量,并进行人工晶状体度数测算,在重硅油取出联合超声乳化白内障摘出人工晶状体植入术后１个月应用Ａ超和ＩＯＬ-Ｍａｓｔｅｒ进行第二次眼轴测量,３个月时进行屈光检查,对两种检查的结果进行对比分析。结果　术前眼轴长度Ａ超测量为（２６．３±３．６）ｍｍ,ＩＯＬ-Ｍａｓｔｅｒ测量为（２６．２±３．７）ｍｍ;术后１个月眼轴长度Ａ超测量为（２６．２±３．６）ｍｍ,ＩＯＬ-Ｍａｓｔｅｒ测量为（２６．２±３．７）ｍｍ。术前术后Ａ超测量结果之间、ＩＯＬ-Ｍａｓｔｅｒ测量结果之间,以及术前ＩＯＬ-Ｍａｓｔｅｒ测量结果与术后Ａ超测量结果之间差异均无统计学意义（均为Ｐ＞０．０５）,而术前Ａ超测量结果与术后ＩＯＬ-Ｍａｓｔｅｒ测量结果差异有统计学意义（Ｐ＝０．０３０）,Ａ超测量结果较ＩＯＬ-Ｍａｓｔｅｒ测量结果眼轴较长。术前ＩＯＬＭａｓｔｅｒ测量的人工晶状体度数预估术后屈光状态为－０．３６～０．０８（－０１１±０．１３）Ｄ,术后３个月等效球镜度为－０．４１～０．１１（－０．１１±０１４）Ｄ。用ＩＯＬ-Ｍａｓｔｅｒ计算的预计术后屈光度与术后真实屈光度比较差异无统计学意义（Ｐ＞０．０５）。结论　对于重硅油Ｏｘ-ａｎｅＨＤ填充眼的眼轴测量,应首选ＩＯＬ-Ｍａｓｔｅｒ测量,对于屈光间质混浊、患者无法固视而不能进行ＩＯＬ-Ｍａｓｔｅｒ检查的患者眼轴可采用Ａ超测量。     

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.     

Intraoperative biometry for intraocular lens (IOL) power calculation at silicone oil removal

PURPOSE: Cataract development is common following retinal detachment surgery that necessitates silicone oil injection. Intraocular lens (IOL) power calculation in the presence of silicone oil is challenging for many reasons. The authors evaluated the accuracy of intraoperative biometry during cataract surgery in silicone-filled eyes. METHODS: Twelve cases of cataract in eyes filled with silicone oil after retinal detachment surgery were included. Preoperatively, keratometric readings were documented. Intraoperative axial length was measured following removal of silicone oil using a sterile probe of the Nidek Echoscan US800 unit. IOL power calculation was computed using the SRK/T formula. This was followed by phacoemulsification and foldable lens implantation. Postoperative refraction allowed evaluation of the accuracy of intraoperative biometry. The predictability of three different formulas was also compared (Holladay, SRK/T, and SRK II). RESULTS: Seven men and five women with a mean age of 50.2 years were included in the study. The mean postoperative spherical equivalent using the described technique was 6.77 +/- 0.43 diopters. SRK/T and Holladay formula had the best predictability for high axial length eyes, whereas the three studied formulas showed no significant differences in predictability in eyes with normal axial length. CONCLUSIONS: Intraoperative biometry proved to have good predictability for the absolute postoperative refractive error in cataract surgery for eyes at the time of silicone oil removal. This predictability was accurate independent of axial length.     

Reliability of the IOLMaster in axial length evaluation in silicone oil-filled eyes

PURPOSE: To assess the reliability of IOLMaster in axial length (AL) measurement in phakic silicone oil-filled vs pseudophakic saline-filled eyes. METHODS: Ten eyes of 10 patients, vitrectomized with silicone oil tamponade and scleral buckled with significant lens opacity were enrolled. Optical biometry with IOLMaster (Carl Zeiss Meditec AG, Germany) was performed 1 day before and 1 week after silicone oil removal and phacoemulsification with artificial intraocular lens (IOL) implantation in order to assess changes in AL measurements. RESULTS: Mean AL was 26.16+/-1.23 mm (range 24.64-28.8 mm) and 26.27+/-1.46 mm (range 25.26-29.6 mm), respectively, the day before and 1 week after silicone oil removal and cataract surgery, and the difference was not statistically significant (P=0.2). CONCLUSIONS: Presence vs absence of silicone oil tamponade as well as phakic vs pseudophakic status in buckled and vitrectomized eyes did not influence the AL measurement by means of no-contact optical biometry, suggesting that such eyes might be candidate for silicone oil removal and cataract surgery at one time.     

Biometry of the silicone oil-filled eye: II

PURPOSE: In phakic silicone oil-filled eyes, removal of the silicone oil can be combined with phacoemulsification and intraocular lens (IOL) implantation. True axial length (AL) of the silicone oil-filled (viscosity 1300 centistokes) eye can be estimated from the measured AL (MAL) obtained on A and/or B scan echography, by multiplying MAL by a conversion factor of 0.71. IOL power can then be calculated using current biometry formulae (SRK/T). This study aims to evaluate the conversion factor in clinical practice. METHODS: Eleven patients undergoing combined removal of silicone oil and phacoemulsification with IOL implant were studied. Patients were divided into two groups. In Group 1 (seven patients), the IOL was placed in the capsular bag and in Group 2 (four patients) the IOL was placed in the ciliary sulcus. Calculated AL (CAL) was obtained by multiplying the MAL of the silicone oil-filled eye (as measured on A or B scan ultrasonagraphy) by the conversion factor of 0.71. IOL power was then estimated using the CAL in the SRK/T formula. The spherical equivalent of the postoperative refractive error was compared to predicted refractive error. RESULTS: The mean difference in actual and predicted refractive error was 0.74 dioptres (D) (standard deviation 0.75 D) for Group 1 and 1.31 D (standard deviation 1.4 D) for Group 2. CONCLUSIONS: The conversion factor of 0.71 corrects for the apparent increase in AL induced by silicone oil of viscosity 1300 centistokes. This allows accurate prediction of the required IOL power in eyes undergoing combined cataract extraction, removal of silicone oil and lens implant. Sulcus placement of the IOL gives a less predictable result than placement in the capsular bag.     

Evaluation of the results of cataract surgery in eyes after silicone oil removal

PURPOSE: To evaluate the results of cataract surgery in eyes after silicone oil removal and comparison of surgical technics. MATERIAL AND METHODS: Eighty-four eyes of 80 patients underwent cataract extraction and IOL implantation after vitrectomy with silicone oil, after its removal. In 50 eyes of group A cataract surgery was performed using the ECCE procedure, in 20 eyes of group B-phacoemulsification was done and in 14 eyes of group C cataract surgery was performed simultaneously with silicone oil removal. Ten eyes of the control group K underwent cataract extraction without IOL implantation. The follow-up was 15.5 +/- 11.2 months. RESULTS: Visual acuity of 6/60 or better was achieved in 65% of eyes. Statistically significant improvement in visual acuity was observed after cataract surgery, compared to the results after vitrectomy in the study group and in the control group. The most frequent complication was posterior capsule opacification, which occurred in 47 eyes (54.6%). CONCLUSIONS: Cataract surgery and IOL implantation in eyes after vitrectomy with silicone oil is safe and achieved visual acuity is similar or better, than before cataract formation. The usefulness of combined cataract surgery and silicone oil removal requires further studies.