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目的分析有晶状体眼人工晶状体(P-IOL)植入术后眩光的发生因素,提出选择合适P-IOL的标准。设计回顾性病例系列。研究对象北京同仁医院104例(104眼)行P-IOL植入术的高度近视患者。方法104例患者植入以角膜为对称设计的房角支撑型Phakic6者22例22眼(Phakic6组)、虹膜固定型Verisyse者54例54眼(Verisyse组)、后房型PRL者28例28眼(PRL组)。依照软件计算的屈光度结果选择P-IOL光学部直径。术后1周询问患者是否有眩光,并用前节相干光断层扫描(OCT)测量术眼瞳孔直径,瞳孔中心与角膜中心、P-IOL光学部中心的相对位置;用Optec6500视功能检查仪检查不同亮度及光照条件(昼、昼+眩光照明、夜、夜+眩光照明)下各空间频率(1.5、3、6、12、18c/d)的对比敏感度(CS)。主要指标对比敏感度、眩光发生率、瞳孔直径、P-IOL光学部位置。结果104只术眼日间均无眩光症状;暗环境或夜间灯光照明下有眩光症状59眼(56.73%)。Phakic6组、Verisyse组、PRL组眩光发生率分别为63.18%(14/22)、55.56%(30/54)、53.27%(15/28)(P=0.691)。所有术跟在昼、昼+眩光照明下,除空间频率1.5 c/d外,术后CS在其余空间频率均较术前显著提高(P均=0.000)。发生眩光的术眼术后夜、夜+眩光照明环境下CS均较术发生者显著降低(P均=0.000)。暗光线下瞳孔直径大于光学部直径的患者(Phakic6组10眼,Verisyse组20眼,PRL组12眼)术后更易发生眩光(P均<0.05)。P-IOL光学部中心偏离瞳孔中心的患者(Phakic6组8眼,Verisyse组10眼,PRL组5眼)术后更易发生眩光(P均<0.05)。结论对于术前瞳孔中心偏离角膜中心的患者,应避免植入以角膜为对称设计的P-IOL;对于术前瞳孔暗环境下>6 mm的术眼,应避免植入光学部直径为5 mm的P-IOL。
Objective To analyze the causes of glare after phacoemulsification with intraocular lens (IOL) and propose a suitable standard for selecting suitable P-IOL. Design retrospective case series. Participants Beijing Tongren Hospital 104 cases (104 eyes) underwent P-IOL implantation of high myopia patients. Methods A total of 104 patients (Phakic6 group, 22 patients with Vericase group, 54 patients with Verisyse group, 28 patients with posterior chamber type PRL, 28 eyes (22 eyes) PRL group). The diameter of the P-IOL optics is selected according to the diopter results calculated by the software. One week after surgery, the patient was asked whether there was glare and the relative position of the pupil center, the center of the cornea, and the center of the P-IOL optics was measured with anterior segment coherence tomography (OCT); the difference was examined using the Optec 6500 visual function tester Contrast sensitivity (CS) at each spatial frequency (1.5, 3, 6, 12, 18c / d) under the light and light conditions (day, day + glare lighting, night, night + glare lighting) The main indicators of contrast sensitivity, glare incidence, pupil diameter, P-IOL optics position. Results All the 104 eyes had no glare during the daytime. There were 59 eyes (56.73%) with glare under dark or night illumination. The incidences of glare in Phakic6 group, Verisyse group and PRL group were 63.18% (14/22), 55.56% (30/54) and 53.27% (15/28), respectively (P = 0.691). All operations followed the daytime, daytime + glare illumination, except for the spatial frequency of 1.5 c / d, postoperative CS in the other spatial frequencies were significantly higher than preoperative (P = 0.000). Postoperative glaucoma surgery night, night + glare lighting CS were significantly lower than the incidence of surgery (P = 0.000). Glaucoma was more likely to occur in patients undergoing dark light (pupils in Phakic6 group, 20 eyes in Verisyse group and 12 eyes in PRL group), whose pupil diameter was larger than the diameter of optics group (all P <0.05). Glaucoma was more likely to occur in patients with P-IOL deviations from the pupil center (8 eyes in Phakic 6 group, 10 eyes in Verisyse group and 5 eyes in PRL group) (all P <0.05). Conclusion Patients with preoperative pupil center deviation from corneal center should avoid implanted P-IOL with corneal symmetry. For operative eyes> 6 mm in preoperative pupil dark environment, the diameter of optics should be 5 mm P-IOL.