前节OCT评估V4c型后房型有晶体眼人工晶体植入术安全性的临床研究

目的探讨前节光学相干断层扫描(OCT)评估V4c型后房型有晶体眼人工晶体(ICL)植入术治疗超高度近视长期安全性的价值。方法 41例(78眼)>-9.0D的超高度近视进行V4c型ICL植入手术患者,测量术前及术后1、3、6、12个月的角膜内皮细胞计数,应用前节OCT及超声生物显微镜(UBM)检测患者术前睫状沟沟到沟距离(WTW)、中央前房深度(ACD)、小梁于虹膜夹角(TIA)及术后各时段拱高、ACD、TIA。分析手术安全性;比较患者术前及术后各时段角膜内皮细胞计数、前节OCT测量指标,术前不同测量方法各参数测量结果 , UBM与前节OCT各参数测量结果。结果所有患者手术顺利,术后4 h内13只眼(12例患者)一过性眼压升高,降眼压处理后至随访结束眼压均平稳,其余患者无其他手术并发症发生。术后1、3、6、12个月,患者角膜内皮细胞计数低于术前,差异具有统计学意义(P<0.05);术后1、3、6、12个月,患者前节OCT测量指标ACD低于术前、TIA小于术前,差异具有统计学意义(P<0.05);术后1、3、6、12个月,患者角膜内皮细胞计数及前节OCT测量指标ACD、TIA、拱高比较差异无统计学意义(P>0.05)。术前WTW应用卡尺手测、角膜地形图(ObscanⅡ)前节分析系统测量、Master、UBM及前节OCT测量结果分别为(11.80±0.36)、(11.75±0.37)、(12.26±1.17)、(11.94±0.41)、(11.91±0.38)mm, Master测量WTW与其他方式比较差异具有统计学意义(P<0.05);术前ACD应用ObscanⅡ前节分析系统测量、Master、UBM及前节OCT测量结果分别为(3.1±0.20)、(3.30±0.17)、(3.11±0.13)、(3.10±0.15)mm, Master测量结果与其他方式比较差异具有统计学意义(P<0.05);术前TIA应用UBM、前节OCT测量结果分别为(40.98±5.82)°、(40.92±5.65)°,比较差异无统计学意义(P>0.05)。术前及术后各时段,前节OCT及UBM测量ACD、TIA及拱高的测量结果比较差异无统计学意义(P>0.05)。结论 V4c型ICL植入术治疗超高度近视无论视力、ICL位置或是眼内情况稳定性均良好,无严重并发症,手术方式安全稳定。应用前节OCT观察术后ICL位置、前房深度及房角情况简易方便,准确无创。测量简单方便且精准,可作为术后常规随访的测量方式。

Clinical study on the safety of V4c posterior chamber intraocular lens implantation evaluated by anterior segment OCT

Objective To discuss the value of anterior segment optical coherence tomography(OCT)in evaluating long-term safety of super-high myopia treated by V4 c posterior chamber intraocular lens implantation(ICL).Methods There were 41 cases(78 eyes)of super high myopia(>-9.0 D)treated by V4 c ICL implantation.The corneal endothelial cells were measured before and 1,3,6,12 months after operation.Postoperative white to white diameter(WTW),anterior chamber depth(ACD),trabecular iris angle(TIA),arch height,ACD,TIA in different periods after operation was detected by anterior segment OCT and ultrasound bio-microscopy(UBM).The safety of operation was analyzed,and corneal endothelial cell count and OCT measurement indexes of anterior segment before operation and at different time period after operation,measurement results of parameters by different measurement methods before operation,and measurement results of UBM and anterior segment OCT parameters was compared.Results All patients were operated successfully,intraocular pressure of 13 eyes(12 patients)increased in 4 h postoperatively.Intraocular pressure was stable until the end of follow-up after the treatment of intraocular pressure reduction.No other complications occurred in other patients.At 1,3,6 and 12 months after operation,the corneal endothelial cell count was lower than that before treatment,and their difference was statistically significant(P<0.05).At 1,3,6 and 12 months after operation,ACD of anterior segment OCT measurement index was lower than that before operation,and TIA was smaller than that before operation.Their difference was statistically significant(P<0.05).At 1,3,6 and 12 months after operation,there was no statistically significant difference in corneal endothelial cell count,ACD,TIA and arch height of anterior segment OCT measurement index(P>0.05).The results of WTW measured by calliper hand,anterior segment analysis system of corneal topographic map(ObscanⅡ),Master,UBM and anterior segment OCT before operation were(11.80±0.36),(11.75±0.37),(12.26±1.17),(11.94±0.41),(11.91±0.38)mm respectively.The difference between Master and other measurement methods was statistically significant(P<0.05).The results of ACD measured by ObscanⅡanterior segment analysis system,Master,UBM and anterior segment OCT before operation were(3.1±0.20),(3.30±0.17),(3.11±0.13)and(3.10±0.15)mm respectively.The difference between Master and other measurement methods was statistically significant(P<0.05).The results of TIA measured by UBM and anterior segment OCT before operation were(40.98±5.82)°and(40.92±5.65)°respectively,and the difference was not statistically significant(P>0.05).There was no statistically significant difference in measurement results of ACD,TIA and arch height of anterior segment OCT and UBM before operation and at different time points after operation(P>0.05).Conclusion V4 c ICL implantation for super-high myopia has good stability regardless of vision,ICL position or intraocular condition,without serious complications,and the operation method is safe and stable.It is simple,convenient,accurate and noninvasive to observe the position of ICL,the depth of anterior chamber and the angle of chamber after operation,which can be used as the measurement method of routine follow-up after operation.