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医学文献
医学文献
虹膜睫状体囊肿对后房型人工晶状体位置的影响
作者:    人气:5921    时间:2009-8-6 10:57:49

   【摘要】    目的:用超声生物显微镜(ultrasound biomicroscopy,UBM)研究虹膜睫状体囊肿对后房型人工晶状体位置的影响。

  方法:在北京大学眼科中心行白内障超声乳化吸出人工晶状体植入术的患者,无角膜手术史,在白内障人工晶状体植入手术前行UBM检查,发现合并虹膜睫状体囊肿者20例(26眼),其中,双眼合并囊肿者6例(12眼),这12眼中只有8眼行白内障人工晶状体植入术,设无虹膜睫状体囊肿者17例(22眼)为对照组,白内障人工晶状体植入术后1mo,对这两组患者复行UBM检查,测量角膜内皮到人工晶状体前表面中央的距离,以及人工晶状体光学部外周12∶00,6∶00,3∶00,9∶00分别到角膜内皮的距离,人工晶状体襻的位置,虹膜睫状体囊肿的位置、大小。并且于术后1mo对这两组患者进行旋光视力检查。应用成组t检验方法分别对数据进行分析。

  结果:(1)虹膜睫状体囊肿的20例(22眼)和对照组白内障人工晶状体植入术后1mo旋光视力均数分别为4.78±0.15, 4.89±0.10,(t=2.30,P=0.03)。(2)虹膜睫状体囊肿患者20例(22眼)中,其人工晶状体外周12∶00,6∶00,3∶00,9∶00分别到角膜内皮的距离差值(最长与最短距离之差)的均数为(0.52±0.29)mm,对照组中人工晶状体光学部外周12∶00,6∶00,3∶00,9∶00分别到角膜内皮的距离差值的均数为(0.28±0.18)mm,两组t=2.26,P=0.03。(3)两组中虹膜后表面到人工晶状体前表面周边12∶00,6∶00的距离差值均数分别为(0.18±0.09)mm,(0.06±0.06)mm,(t=3.51,P=0.002)。(4)虹膜睫状体囊肿的20例(22眼)和对照组术后1mo的角膜内皮到人工晶状体前表面的中央距离均数分别为(3.77±0.10)mm,(3.66±0.29)mm,(t=1.34,P=0.20)。(5)本组虹膜睫状体囊肿大小不一,最大的囊肿矢状面面积为1.592mm2(最大矢状面面积),最小的囊肿矢状面面积为0.081mm2(最大矢状面面积)。1例(1眼)术前合并囊肿者,术后囊肿消失。

  结论:虹膜睫状体囊肿,对人工晶状体位置有一定影响,对术后患者的旋光视力有一定影响,对术后中央前房深度没有影响,囊肿术后可以消失。

【关键词】  虹膜睫状体囊肿 人工晶状体 眩光视力

  Effect of iris ciliary body cyst on posterior chamber intraocular len location

  Xin Zhao, XueMin Li, Xin Wang, Wei Wang

  Department of Ophthalmology, the Second Hospital of Beijing, Beijing 100031, China; Eye Center of Peking University, Beijing 100083, China

  Abstract

  AIM: To research the effect of iris ciliary body cyst on posterior chamber intraocular len location by using the Ultrasound biomicroscopy.

  METHODS: The patients, without corneal surgical history in Eye Center of Peking University, were examined by ultrasound biomicroscopy before underwent cataract ultrasound phacoemulsification and intraocular len implantation. It was found that 20 cases (26 eyes) were with ciliary body cyst. Thereinto, 6 cases (12 eyes) were with both biocular iris ciliary body cyst, in which, only 8 eyes received cataract IOL implantation. Seventeen cases (22 eyes) without ciliary body cyst were as control group. One month after cataract IOL implantation, the patients in two groups were rechecked by Ultrasound biomicroscopy, including measuring the distance from endothelial to the center anterior surface of IOL, the distance from endothelial to the IOL optic area outside surrounding 12∶00, 6∶00, 3∶00, and 9∶00, and the location of IOL, the location and size of iris ciliary body cyst. Glare visual acuity of these two groups was tested one month after operation. Data base was analyzed by using pairedt test.

  RESULTS: At postoperative month 1, the glare visual acuity means of 20 cases (22 eyes) in iris ciliary body cyst group and control group were 4.78±0.15 and 4.89±0.10 (t=2.30, P=0.03). The means of difference distances (the difference between the longest and shortest) from endothelial to the IOL outside surrounding of 20 cases (26 eyes) in iris ciliary body cyst group and from endothelial to the IOL optic area outside surrounding of eyes in control group at 12∶00, 6∶00, 3∶00, and 9∶00 were (0.52±0.29)mm and (0.28±0.18)mm, respectively, (t=2.26, P=0.03). The means of difference distance from iris posterior surface to the IOL anterior surface surrounding 12∶00, and 6∶00 in two groups were (0.18±0.09)mm and (0.06±0.06)mm (t=3.51, P=0.002). The means of center distance from endothelial to the IOL anterior surface in 20 cases (26 eyes) with ciliary body cyst and in control group one month after operation were (3.77±0.10)mm and (3.66±0.29)mm (t=1.34, P=0.20). In iris ciliary body cyst group, iris ciliary cysts were unequal size, the biggest arrowy proportion of cyst was 1.592mm2, and the smallest was 0.081mm2. The cyst was gone after operation in 1 case (1 eye) with cyst .

  CONCLUSION: Iris ciliary cyst has certain influence to the location of IOL, also to the glare visual acuity of patients who performed surgery. Iris ciliary cyst has no influence to the center depth of anterior chamber and the cyst can disappear after surgery.

  KEYWORDS: iris ciliary cyst; IOL; glare visual acuity

  0引言
   
  据报道睫状体囊肿在玻璃体视网膜疾病患者中的发病率为10%[1],虹膜睫状体囊肿在原发性闭角性青光眼中的发病率为6.3%[2]。看来虹膜睫状体囊肿在人群中是一种发生率较高的疾病。如果白内障患者合并虹膜睫状体囊肿,虹膜睫状体囊肿对人工晶状体的位置是否存在影响?影响程度如何?会不会因为虹膜睫状体囊肿的存在影响到患者的手术后的视功能,进而影响到老年人的生活质量。为了明确上述疑问,避免上述问题的发生,我们针对这一问题进行下面的研究。

  1对象和方法

  1.1对象  自200509/200511在北京大学眼科中心行白内障超声乳化吸出人工晶状体植入术的患者,无角膜手术史,在白内障人工晶状体植入术前均行UBM检查,发现虹膜睫状体囊肿患者20例(26眼),其中男12例(15眼),女8例(11眼),年龄:56~84岁,。双眼合并囊肿者6例(12眼),这12眼中只有8眼行白内障人工晶状体植入术。设无虹膜睫状体囊肿患者17例(22眼)为对照组,两组所有病例白内障及人工晶状体植入术均顺利,均为角膜切口,且由同一术者完成。

  1.2方法

  1.2.1超声生物微镜检查  术后1mo两组患者再次行UBM检查,并检查旋光视力。UBM检查在同一间无干扰的明亮的房间内由同一人完成。UBM采用PARADIGM制造的P40仪进行,探头为50MHz,测量的有效深度为4.0mm,精确度为50μm,范围为5.5mm×5.5mm。测量:(1)角膜内皮中央到人工晶状体前表面中央直线距离(图1)。(2)角膜内皮到人工晶状体前表面周边12∶00,6∶00的直线距离,垂直于周边部人工晶状体表面。(3)角膜内皮到人工晶状体前表面周边3∶00,9∶00的直线距离,垂直于周边人工晶状体表面(图3,4)。(4)虹膜后表面到人工晶状体前表面周边12∶00,6∶00的垂线距离(图2)。

  1.2.2旋光视力的检查  在一间有对数视力表的暗房间里,只开视力表的灯,查一次视力,然后用灯光在患者颞侧照射患者的眼睛,再查一次视力,在第二次视力的检查中灯光要持续照射直到视力检查完,该视力为眩光视力。
   
  统计学处理:分析工具采用SPSS 12.0软件包,所有实验数据均采用独立样本t检验进行统计学分析,P<0.05作为差异有统计学意义。

  图1  角膜内皮到人工晶状体前表面中央距离(略)

  图2  虹膜后表面到人工晶状体前表面垂直距离(略)

  图3  人工晶状体外周3∶00到角膜内皮距离,垂直于人工晶状体外周前表面(略)

  图4  人工晶状体外周9∶00到角膜内皮距离,垂直于人工晶状体前表面(略)

  表1  手术后眩光视力及UBM测量统计分析表(略)

  表2  面积大于1.00mm×1.00mm的虹膜睫状体囊肿临床资料(略)

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