IOLMaster与A型超声校正法测量硅油眼眼轴的对照研究

摘要

背景 白内障摘出联合人工晶状体(IOL)植入术是提高患者生活质量的方法,但传统的硅油眼IOL度数的测量往往较实际的度数偏大.光学相干生物测量技术已被广泛用于IOL度数的测量,但需要探求其所测IOL度数与实际值的差别.目的 探讨并比较IOLMaster及眼部A型超声生物测量校正方法测量硅油填充眼眼轴的准确性,以及2种测量方法在计算IOL度数方面的差别.方法 42例44只硅油填充眼按眼压不同分为≥10 mmHg组29眼和＜10 mmHg组15眼,分别用IOLMaster和眼部A型超声测量校正2种方法在硅油取出术前和术后测量眼轴,利用术前测量的眼轴及角膜曲率推算理论IOL度数,评价IOLMaster测量硅油填充眼眼轴的优点及其预测IOL度数的临床意义.结果 对于眼压≥10 mmHg的硅油填充眼,IOLMaster测量法与A型超声校正法所得眼轴数值之间差异有统计学意义(P=0.015),但硅油取出术后与术前眼轴差异无统计学意义(P=0.10),IOLMaster测量硅油眼眼轴的误差值均低于A型超声法,差异有统计学意义(ZIOLMaster参照=-2.236,P=0.025),而且关于预测的IOL度数误差,IOLMaster测量法也小于A型超声校正法;对于＜10 mmHg的硅油填充眼,IOLMaster和A型超声校正法在硅油取出术后所测的眼轴和IOL度数均明显低于硅油取出前所测值,差异均有统计学意义(P=0.006).结论 眼压稳定、眼底情况较好的硅油眼行硅油取出联合IOL植入术前采用IOLMaster测量法预测IOL度数的准确性和稳定性优于A型超声校正法,但对于术前眼底情况复杂、手术次数多、眼压不稳定的硅油眼,2种方法均无法准确预测术后眼轴及IOL度数,建议硅油取出后再行IOL植入术.%Background Combination of cataractopiesis with intraocular lens (IOL) is believed to improve the patient' s quality of life. However, 1OL power and axial length measured by traditional method in silicone-filled eye is normally bias to the actual levels. The optical coherence biometry technology has been widely used in the measurement of IOL, but little studies have been conducted to demonstrate the IOL power difference between those methods. Objective This study was to evaluate the predictability of IOL power calculations using the IOLMaster and adjusting contact ultrasound A-scan method in silicone oil-filled eyes. Methods Forty-four silicone-filled eyes of 42 patients were divided into 2 groups according to the intraocular pressure (IOP) ( group A: ≥ 10 mmHg group,29 eyes;group B:＜10 mmHg group, 15 eyes). IOLMaster and ocular ultrasonic measurement were used to measure the axis length before and after silicone oil was removed. The preoperatively measured eye axis and cornea curve were used to calculate the theoretical IOL. Results In normal IOP group ( T≥ 10 mmHg,29 eyes), the precision and stability of IOLMaster for axial length ( AL ) measurements and IOL power calculations were better than adjusted ultrasound A-scan( ZIOLMasterdependent = -2. 236, P = 0. 025 ), although in low IOP group ( T＜ 10 mmHg, 15 eyes),there were too much differences in axial length mesurement and IOL power calculation between the IOLMaster and adjusted ultrasound A-scan, so the post-operative imformation was not predicted accurately. Conclusion For anticipatory normal postoperative IOP eyes, the refractive outcome in cataract surgery in silicone oil-filled eyes can be predicted reliably and accurately with IOLMaster. But for complicated or anticipatory unstable postoperative IOP eyes,secondary implantation of IOL would be better.