有晶状体眼后房型人工晶状体植入术后前房角的改变及相关因素分析

目的：探讨有晶状体眼后房型人工晶状体植入术后不同时间的前房角变化，分析影响术后前房角度数（ACA）的相关因素。方法：前瞻性非随机的连续病例研究。连续收集2018年9月至2019年2月在郑州大学第一附属医院眼科屈光中心接受有孔型有晶状体眼后房型人工晶状体（ICL）植入术的近视患者81例（81眼），患者术前，术后1 d、1个月和6个月行Visante眼前段光学相干断层扫描（OCT）检 查，测量术前、术后鼻侧和颞侧ACA及术后拱高。分析术后ACA与术前等效球镜度（SE）、眼轴长度、水平角膜直径、前房深度、前房容积、水平角膜曲率、术前ACA、ICL直径和术后拱高的相关性。 采用重复测量方差分析比较患者不同时间点眼前段各项参数的变化，两两比较采用 Bonferroni检验。 相关性分析采用Pearson相关或Spearman相关分析。结果：术后1 d、1个月和6个月的ACA比较差异 均无统计学意义，术后的鼻侧ACA较术前减少45%～50%（F=268.73，P<0.001），术后的颞侧ACA 较术前减少44%～49%（F=333.40，P<0.001）。ICL植入术后1 d、1个月和6个月的平均拱高分别为 （640±180）μm、（540±150）μm和（530±160）μm，差异具有统计学意义（F=54.14，P<0.001）；术后 1个月内拱高下降趋势明显，术后1个月至术后6个月期间拱高下降趋势明显减缓。 ICL植入术后鼻 侧ACA与术前前房容积、术前前房深度和术前ACA呈正相关（r=0.426，P=0.003；r=0.377，P=0.008； r=0.525，P<0.001）；与ICL直径、拱高、术前SE、眼轴长度、水平角膜曲率和水平角膜直径无相关性。 ICL植入术后颞侧ACA与术前前房容积、术前前房深度和术前ACA呈正相关（r=0.392，P=0.006； r=0.376，P=0.008；r=0.594，P<0.001），与ICL直径、拱高、术前SE、眼轴长度、水平角膜曲率和水平角膜直径无相关性。结论：ICL植入术后前房角明显减小，随访期内患者前房角开放度数基本稳定， 没有进一步变窄。

The Alteration of the Anterior Chamber Angle and Related Factors after Posterior Chamber Intraocular Lens Implantation in Phakic Eyes

Objective: To observe the changes in the anterior chamber angle at different times after phakic posterior chamber intraocular lens (EVO ICL V4c) implantation and to analyze the related factors affecting the postoperative anterior chamber angle (ACA). Methods: A prospective, nonrandomized continuous study was conducted. Eighty-one myopic patients (81 eyes) who underwent posterior chamber intraocularlens implantation from September 2018 to February 2019 were recruited in the Refractive Center of the First Affiliated Hospital of Zhengzhou University. Patients underwent Visante anterior segment optical coherence tomography (OCT) before surgery, and 1 day, 1 month and 6 months after surgery to measure the preoperative and postoperative data of the nasal/temporal anterior chamber and vault. Data analysis included the correlation between postoperative ACA and axial length, horizontal corneal diameter (white to white), anterior chamber depth, anterior chamber volume, horizontal keratometry, anterior chamber angle, ICL diameter and postoperative vault. Repeated measures analysis of variance was used to compare the changes in various parameters of the anterior segment at different time points in patients, and the Bonferroni test was used for pairwise comparisons. Correlation analysis was performed using Pearson correlation or Spearman correlation. Results: There was no significant difference in the anterior chamber angle at 1 day, 1 month and 6 months after the operation, while the postoperative nasal ACA was reduced by 45%-50% compared with preoperative ACA (F=268.73, P<0.001). The postoperative temporal ACA decreased by 44%-49% compared with preoperative ACA (F=333.40, P<0.001). The mean vault was 640±180 μm at 1 day, 540±150 μm at 1 month, and 530±160 μm at 6 months after ICL V4c implantation. The differences were statistically significant (F=54.14, P<0.001). The declining trend in vault was obvious within 1 month after the operation, while the declining trend in vault obviously slowed from 1 month to 6 months after the operation. There was a positive correlation between anterior chamber volume, anterior chamber depth and preoperative angle opening after ICL implantation (r=0.426, P=0.003; r=0.377, P=0.008; r=0.525, P<0.001), without significant correlations between anterior chamber angle opening and ICL diameter, arch height, preoperative spherical power, axial length, horizontal keratometry and white to white. There were positive correlations between anterior chamber volume, anterior chamber depth and preoperative angle opening after ICL implantation (r=0.392, P=0.006; r=0.376, P=0.008; r=0.594, P<0.001), without significant correlations between anterior chamber angle opening and ICL diameter, arch height, preoperative spherical power, axial length, horizontal keratometry and white to white. Conclusions: The anterior chamber angle is significantly reduced after posterior chamber intraocular lens implantation in phakic eyes, and the anterior chamber angle is basically stable during the follow-up period without further narrowing.