高度近视患者后房型有晶状体眼人工晶状体植入术后拱高的变化及其影响因素

目的　分析高度近视患者行有晶状体眼后房型人工晶状体(ICL)植入术后拱高的变化及其影响因素，并给出术后不同时间点拱高的预测方程。方法　分析2020年8月至11月于徐州市第一人民医院眼科收治的拟行ICL植入术治疗高度近视的患者32例63眼的临床资料,术前记录患者的前房角度、前房深度、前房容积、角膜厚度、白到白间距(WTW)、睫状沟直径（STS）、术前等效球镜度和自然晶状体厚度，同时记录术中植入的ICL尺寸，使用Pentacam眼前节分析系统测量患眼术后1 d、1个月、6个月、12个月的拱高,分析上述观察指标对于术后拱高的影响。通过多元线性逐步回归分析,去除存在共性的变量,筛选出独立因素。以独立因素作为自变量，ICL术后拱高作为因变量，分析各因素对于ICL术后拱高的影响是否有统计学意义。结果　本研究入组患者年龄为（26.59±5.73）岁，术后1个月拱高显著低于术后1 d，术后6个月拱高显著低于术后1个月，术后12个月拱高显著低于术后6个月,差异均有统计学意义(均为P<0．05)。多元线性逐步回归分析结果显示，前房深度和自然晶状体厚度均是高度近视患者ICL植入术后拱高的独立影响因素(均为P< 0.05)。Spearman相关性分析结果显示，术后拱高与前房深度、前房容积和ICL尺寸均呈正相关，与自然晶状体厚度呈负相关（均为P<0.05）。影响高度近视患者 ICL 植入术后1 d、1个月、6个月、12个月拱高的回归方程分别为:术后1 d拱高（μm)=258.226-435.606×自然晶状体厚度(mm)+291.971×前房深度(mm)+75.134×ICL尺寸(mm)+0.166×前房容积(mm³)；术后1个月拱高(μm)=545.797-391.858×自然晶状体状厚度(mm)+221.224×前房深度(mm)+44.786×ICL尺寸(mm)+0.505×前房容积(mm³)；术后6个月拱高(μm)=208.770-287.950×自然晶状体厚度(mm)+254.127×前房深度(mm)+30.280×ICL尺寸(mm)+0.619×前房容积(mm³)；术后12个月拱高(μm)=0.999-251.694×自然晶状体厚度(mm)+250.972×前房深度(mm)+36.120×ICL尺寸(mm)+0.599×前房容积(mm³)。结论　高度近视患者行ICL植入术后12个月内拱高呈降低趋势,前房深度、前房容积、ICL尺寸、自然晶状体厚度均是影响术后拱高的重要因素。

Vault changes in patients with high myopia after the implantation of an implantable collamer lens and their influencing factors

Objective　To analyze the vault changes in patients with high myopia after the implantation of an implantable collamer lens (ICL) and their influencing factors, and to provide the prediction equation of vault in different periods after operation. Methods　A total of 63 eyes from 32 patients who received ICL implantation to treat high myopia at the Department of Ophthalmology, Xuzhou First People’s Hospital from August to November 2020 were recruited in this study. Preoperative anterior chamber angle (ACA), anterior chamber depth (ACD), anterior chamber volume (ACV), corneal thickness (CT), white-to-white distance (WTW), sulcus-to-sulcus diameter (STS), spherical equivalent (SE), and lens thickness (LT), as well as intraoperative ICL size, were recorded, and their effect on the postoperative vault was analyzed. The vault at 1 day, 1 month, 6 months, and 12 months following the implantation was measured by Pentacam. Through multiple linear stepwise regression analysis, the common variables were eliminated and the independent factors were selected. With the independent factor as the independent variable and the postoperative vault as the dependent variable, the influence of said factors on the postoperative vault was analyzed. Results　Patients enrolled in this study were (26.59±5.73) years old. The vault at 1 month after operation was significantly lower than that at 1 day after operation (P<0.05). The vault at 6 months after operation was significantly lower than that at 1 month after operation (P<0.05). The vault at 12 months after operation was significantly lower than that at 6 months after operation (P<0.05). Multiple linear stepwise regression analysis results showed that ACD and LT were independent factors affecting the vault after ICL implantation in patients with high myopia (both P<0.05). Spearman’s correlation analysis results showed that the postoperative vault was positively correlated with ACD, ACV and ICL size, and negatively correlated with LT (all P<0.05). The regression equations affecting the vault of patients with high myopia at 1 day, 1 month, 6 months, and 12 months after ICL implantation were as follows: Vault (1 d, μm)=258.226-435.606×LT (mm)+291.971×ACD (mm)+75.134×ICL size (mm)+0.166×ACV (mm³), Vault (1 month, μm)=545.797-391.858×LT (mm)+221.224×ACD (mm)+44.786×ICL size (mm)+0.505×ACV (mm³), Vault (6 months, μm)=208.770-287.950×LT (mm)+254.127×ACD (mm)+30.280×ICL size (mm)+0.619×ACV (mm³), and Vault (12 months, μm)=0.999-251.694×LT (mm)+250.972×ACD (mm)+36.120×ICL size (mm)+0.599×ACV (mm³). Conclusion　The vault in patients with high myopia is reduced in 12 months following the ICL implantation. ACD, ACV, ICL size, and LT are important factors affecting the postoperative vault.