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      1. 簡體 | English
        醫學文獻
        醫學文獻
        虹膜睫狀體囊腫對后房型人工晶狀體位置的影響
        作者:    人氣:6316    時間:2009-8-6 10:57:49

           【摘要】    目的:用超聲生物顯微鏡(ultrasound biomicroscopy,UBM)研究虹膜睫狀體囊腫對后房型人工晶狀體位置的影響。

          方法:在北京大學眼科中心行白內障超聲乳化吸出人工晶狀體植入術的患者,無角膜手術史,在白內障人工晶狀體植入手術前行UBM檢查,發現合并虹膜睫狀體囊腫者20例(26眼),其中,雙眼合并囊腫者6例(12眼),這12眼中只有8眼行白內障人工晶狀體植入術,設無虹膜睫狀體囊腫者17例(22眼)為對照組,白內障人工晶狀體植入術后1mo,對這兩組患者復行UBM檢查,測量角膜內皮到人工晶狀體前表面中央的距離,以及人工晶狀體光學部外周12∶00,6∶00,3∶00,9∶00分別到角膜內皮的距離,人工晶狀體襻的位置,虹膜睫狀體囊腫的位置、大小。并且于術后1mo對這兩組患者進行旋光視力檢查。應用成組t檢驗方法分別對數據進行分析。

          結果:(1)虹膜睫狀體囊腫的20例(22眼)和對照組白內障人工晶狀體植入術后1mo旋光視力均數分別為4.78±0.15, 4.89±0.10,(t=2.30,P=0.03)。(2)虹膜睫狀體囊腫患者20例(22眼)中,其人工晶狀體外周12∶00,6∶00,3∶00,9∶00分別到角膜內皮的距離差值(最長與最短距離之差)的均數為(0.52±0.29)mm,對照組中人工晶狀體光學部外周12∶00,6∶00,3∶00,9∶00分別到角膜內皮的距離差值的均數為(0.28±0.18)mm,兩組t=2.26,P=0.03。(3)兩組中虹膜后表面到人工晶狀體前表面周邊12∶00,6∶00的距離差值均數分別為(0.18±0.09)mm,(0.06±0.06)mm,(t=3.51,P=0.002)。(4)虹膜睫狀體囊腫的20例(22眼)和對照組術后1mo的角膜內皮到人工晶狀體前表面的中央距離均數分別為(3.77±0.10)mm,(3.66±0.29)mm,(t=1.34,P=0.20)。(5)本組虹膜睫狀體囊腫大小不一,最大的囊腫矢狀面面積為1.592mm2(最大矢狀面面積),最小的囊腫矢狀面面積為0.081mm2(最大矢狀面面積)。1例(1眼)術前合并囊腫者,術后囊腫消失。

          結論:虹膜睫狀體囊腫,對人工晶狀體位置有一定影響,對術后患者的旋光視力有一定影響,對術后中央前房深度沒有影響,囊腫術后可以消失。

        【關鍵詞】  虹膜睫狀體囊腫 人工晶狀體 眩光視力

          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
           
          據報道睫狀體囊腫在玻璃體視網膜疾病患者中的發病率為10%[1],虹膜睫狀體囊腫在原發性閉角性青光眼中的發病率為6.3%[2]??磥砗缒そ逘铙w囊腫在人群中是一種發生率較高的疾病。如果白內障患者合并虹膜睫狀體囊腫,虹膜睫狀體囊腫對人工晶狀體的位置是否存在影響?影響程度如何?會不會因為虹膜睫狀體囊腫的存在影響到患者的手術后的視功能,進而影響到老年人的生活質量。為了明確上述疑問,避免上述問題的發生,我們針對這一問題進行下面的研究。

          1對象和方法

          1.1對象  自200509/200511在北京大學眼科中心行白內障超聲乳化吸出人工晶狀體植入術的患者,無角膜手術史,在白內障人工晶狀體植入術前均行UBM檢查,發現虹膜睫狀體囊腫患者20例(26眼),其中男12例(15眼),女8例(11眼),年齡:56~84歲,。雙眼合并囊腫者6例(12眼),這12眼中只有8眼行白內障人工晶狀體植入術。設無虹膜睫狀體囊腫患者17例(22眼)為對照組,兩組所有病例白內障及人工晶狀體植入術均順利,均為角膜切口,且由同一術者完成。

          1.2方法

          1.2.1超聲生物微鏡檢查  術后1mo兩組患者再次行UBM檢查,并檢查旋光視力。UBM檢查在同一間無干擾的明亮的房間內由同一人完成。UBM采用PARADIGM制造的P40儀進行,探頭為50MHz,測量的有效深度為4.0mm,精確度為50μm,范圍為5.5mm×5.5mm。測量:(1)角膜內皮中央到人工晶狀體前表面中央直線距離(圖1)。(2)角膜內皮到人工晶狀體前表面周邊12∶00,6∶00的直線距離,垂直于周邊部人工晶狀體表面。(3)角膜內皮到人工晶狀體前表面周邊3∶00,9∶00的直線距離,垂直于周邊人工晶狀體表面(圖3,4)。(4)虹膜后表面到人工晶狀體前表面周邊12∶00,6∶00的垂線距離(圖2)。

          1.2.2旋光視力的檢查  在一間有對數視力表的暗房間里,只開視力表的燈,查一次視力,然后用燈光在患者顳側照射患者的眼睛,再查一次視力,在第二次視力的檢查中燈光要持續照射直到視力檢查完,該視力為眩光視力。
           
          統計學處理:分析工具采用SPSS 12.0軟件包,所有實驗數據均采用獨立樣本t檢驗進行統計學分析,P<0.05作為差異有統計學意義。

          圖1  角膜內皮到人工晶狀體前表面中央距離(略)

          圖2  虹膜后表面到人工晶狀體前表面垂直距離(略)

          圖3  人工晶狀體外周3∶00到角膜內皮距離,垂直于人工晶狀體外周前表面(略)

          圖4  人工晶狀體外周9∶00到角膜內皮距離,垂直于人工晶狀體前表面(略)

          表1  手術后眩光視力及UBM測量統計分析表(略)

          表2  面積大于1.00mm×1.00mm的虹膜睫狀體囊腫臨床資料(略)

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