后发性白内障相关因素的临床研究

目的观察超声乳化白内障吸除联合折叠人工晶状体植入术后后发性白内障(posteriorcapsuleopacification,PCO)发生的相关因素及其特点。方法随访观察394例(440只眼)白内障患者超声乳化白内障吸除联合囊袋内折叠人工晶状体植入术后的视力,用内置数码摄像头Zeiss120裂隙灯进行眼底后反光裂隙照相,转化成数码图像输入计算机,观察人工晶状体位置、连续环形撕囊和后囊膜混浊等情况。随访时间2～58个月,平均14个月。按照晶状体类型共分为6组Sensar组113例(123只眼),Acrysof三片组129例(157只眼),Acrysof一片组79例(84只眼),SC60B组23例(26只眼),硅凝胶组50例(50只眼)。获得的照片使用德国EPCO2000软件分析,对PCO程度进行评分并将各组进行比较分析。结果完全没有PCO的有19只眼(占4.32%),存在PCO的有421只眼(占95.68%),PCO波及瞳孔中央3mm的有274只眼(占62.27%)。按人工晶状体光学面材料分组的两组中,对应PCO数值进行比较,总分差异无显著性(t=1.470,P=0.143);按照襻的成角分组的四组中,所对应的PCO数值中1级混浊的数值比较,差异有显著性(F=4.054,P=0.007);按边缘设计不同分组的两组中,对应PCO数值比较,总分差异有显著性(t=3.763,P=0.0001);根据连续环形撕囊分组的3组中,所对应的PCO数值比较,总分差异有显著性(F=3.689,P=0.026)。结论后囊膜混浊的发生与人工晶状体材料无相关性;襻与光学面成角为10°的人工晶状体对PCO的早期形成有抑制作用;直角边缘设计可以减少PCO的形成;连续环形撕囊口完全覆盖人工晶状体光学面抑制了后囊膜混浊的发生几率。

Clinical study of posterior capsule opacification

Objective To study the factors that influence the incidence of posterior capsule opacification (PCO) after implantation of a foldable intraocular lens(IOL).Methods A consecutive series of 440 eyes (394 cases) underwent phacoemusification with implantation of a foldable IOL. Patients were divided into 5 groups based on the type of IOL implant: hydrophobic acrylic AMO Sensar AR40e; hydrophobic acrylic Acrysof MA60BM and MA60MA (Alcon); hydrophobic acrylic Acrysof SA60AT or SA30AL; hydrophilic acrylic MDR SC60B-OUV; hydriphobic silicone CeeOn 911A?CeeOn 912 or CeeOn 920 (Pharmacia). Each patient's postoperative visual acuity was measured. Photographs of PCO were taken with a Zeiss120 slit lamp with a digital camera after the pupil was dilated and evaluated with an EPCO2000.Results PCO occurred in 421 eyes (421/440, 95.68%). The differences in the PCO scores for the hydrophobic acrylic group and silicone group were not significant (t=1.470,P=0.143). All eyes were divided into 4 groups based on factors related to the IOL and haptic angulation. The difference between the 10 degree group and the other groups for first grade of PCO was significant (F=4.054,P=0.007). The difference in the PCO scores in the square truncated edge designed group and in the round tapered edge designed group was significant (t=3.763,P=0.0001). All cases were divided into 3 groups based on the size and location of the CCC. The PCO scores among the three groups were significantly different (F=3.689,P=0.026). The lowest score occurred when the CCC completely covered the optics.Conclusion There was no correlation between the material used in the optics of the IOL and PCO. The IOL with a 10 degree haptic angulation can decrease the incidence of the PCO. IOL optic design with a square truncated edge was a preventive factor for PCO. Moderate CCC with the diameter slightly smaller than that of the IOL optic can prevent PCO.