唐丽,秦明敏,张甦炯,叶常虹,夏媛玲,陈炜
TANG Li,QING Minmin,ZHANG Sujiong,YE Changhong,XIA Yuanlin,CHEN Wei

• 1:贵州医科大学附属医院眼科
• 2:贵州医科大学

摘要(Abstract)：

目的:比较光学相干生物测量仪(IOL Master)和A型超声测量(A-scan)在白内障合并黄斑病变眼轴测量和人工晶体测算的准确性及术后屈光状态的评价。方法:选取白内障合并黄斑病变需行超声乳化吸出并人工晶体植入术患者38例(46只眼),分别于术前和术后3个月检查术眼的视力并比较;术前采用光学相干断层扫描(OCT)检查术眼视网膜中央厚度(CRT);术前分别用IOL Master和A-scan测量术眼的眼轴长度(AL),根据AL选择人工晶体计算公式SRK-T或Haigis公式确定植入人工晶体(IOL)的度数、目标屈光度及预留的屈光度数并比较;采用Bland-Altman法分析2种测量方法的一致性,采用Pearson相关分析2种方法 AL差值与CRT的相关性;比较2种测量方法预留屈光度数、术后3个月验光的绝对屈光误差(AE)及屈光漂移类型的差异。结果:患者术眼术后3个月裸眼视力较术前提高(P <0. 05); Bland-Altman分析结果显示,2种测量方法 AL差值的95%医学参考范围为-0. 77～0. 89 mm,其中最大差值的绝对值为0. 45 mm; 2种测量方法 AL的差异无统计学意义(Z=-1. 778,P=0. 075),且AL的差值与CRT无相关性(r=0. 087,P=0. 564); IOL Master方法术后3个月AE值较A-scan更接近于0 D(P <0. 001); 2种测量方法术后3个月屈光漂移均以近视漂移为主,且近视漂移检出和AE介于0. 00～1. 00 D的比例均表现为测量方法 IOL Master> A-scan(P <0. 01)。结论:IOL Master和A-scan在测量白内障合并黄斑病变患者的AL上一致性好,与CRT无相关性;术后2种测量方法的屈光漂移均表现为近视漂移为主,且IOL Master准确性优于A-scan。
Objective: To compare the accuracy of IOL Master and A-scan in the measurement of axial length and intraocular lens in cataract patients with macular disease, and to evaluate the postoperative refractive status. Methods: 46 eyes of 38 patients with macular disease complicated with cataract were selected and phacoemulsification and intraocular lens implantation were performed. The visual acuity of the operated eyes was compared before operation and 3 months after operation.Preoperative central retinal thickness( CRT) was measured using optical coherence tomography( OCT). Axial length( AL) was measured by IOL Master and A-scan preoperatively. According to the different lengths of the AL,the intraocular lens formula( SRK-T) or Haigis formula was selected to determine the degree of intraocular lens( IOL),the target diopter and the reserved diopter. BlandAltman method was used to analyze the consistency of the two methods. Pearson correlation was used to analyze the correlation between the difference between axial measurement and CRT. The differences of the reserved diopter,the absolute refractive error( AE) and the type of refractive excursion were compared between the two measuring methods. Results: The difference of uncorrected visual acuity between preoperative and postoperative 3 months was statistically significant( P < 0. 05). Bland-Altman analysis showed that the 95% medical reference range of AL measurement difference between IOL Master group and A-scan group was-0. 77-0. 89 mm,and the absolute value of the maximum difference was 0. 45 mm. There was no significant difference in AL between IOL Master and A-scan( Z =-1. 778,P = 0. 075),and there was no correlation between the difference value of the axial length and CRT( r = 0. 087,P = 0. 564). The AE of IOL Master was closer to 0 D than that of A-scan3 months after operation. Myopic excursion was the main refractive error in both measurements 3 months after surgery,and the ratio of myopia drift detection and AE between 0. 00 D and 1. 00 D in IOL Master was higher than that in A-scan( P < 0. 01). Conclusion: There is good agreement between IOL Master and A-scan in AL measurement of cataract with macular disease,which is independent of the CRT. The refractive excursion of the two methods is mainly myopic drift,and the biometrics accuracy of IOL Master is better than that of A-scan.

关键词(KeyWords)： 白内障;黄斑病变;光学相干生物测量仪;A型超声;眼轴;中央视网膜厚度
cataract;macular diseases;intraocular lens Master(IOL Master);A ultrasound scan(A-scan);axial length;central retina thickness(CRT)

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅联合基金项目[黔科合LH字(2016)7264]

作者(Author): 唐丽,秦明敏,张甦炯,叶常虹,夏媛玲,陈炜
TANG Li,QING Minmin,ZHANG Sujiong,YE Changhong,XIA Yuanlin,CHEN Wei

DOI: 10.19367/j.cnki.2096-8388.2020.09.014

参考文献(References)：

• [1]OLSEN T. Sources of error in intraocular lens power calculation[J]. Journal of Cataract and Refractive Surgery,1992,18(2):125-129.
• [2]RUANGSETAKIT V. Comparison of accuracy in intraocular lens power calculation by measuring axial length with immersion ultrasound biometry and partial coherence interferometry[J]. Journal of the Medical Association of Thailand,2015,98(11):1112-1118.
• [3]KITAGUCHI Y,YANO S,GOMI F. Axial length estimation error caused by hidden double-peak on partial coherence interferometry in an eye with epiretinal membrane:a case report[J]. Clinical Ophthalmology,2014,13(8):555-559.
• [4]SHENTU X C,CHENG Y L,CHEN Z Q,et al. Differences in intraocular lens power calculation in patients with sub-foveal choroidal neovascularization[J]. International Journal of Ophthalmology,2019,12(1):172-174.
• [5]魏丽清，陈榆，廉恒丽，等．SRK/T公式与优化Haigis公式在高度近视眼中的应用比较[J]．中华眼视光学与视觉科学杂志，2016,12(6):747-750,756.
• [6]杨文利．人工晶状体屈光度计算专家共识与解读[M]. 2019版．北京:人民卫生出版社，2019:88.
• [7]OLSEN T. Theoretical approach to intraocular lens calculation using Gaussian optics[J]. Journal of Cataract and Refractive Surgery,1987,13(2):141-145.
• [8]王成，董肖娜，项华中，等．眼轴长度测量方法及进展研究[J]．光学仪器，2019,41(2):72-79.
• [9]TABANDEH H,CHAUDHRY N A,BOYER D S,et al.Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy[J]. Journal of Cataract and Refractive Surgery,2012,38(4):677-682.
• [10]BUENOGIMENO I,ESPAAGREGORI E,GENESAMPEDRO A,et al. Relationship among corneal biomechanics,refractive error,and axial length[J]. Optom Vis Sci,2014,91(5):507-513.
• [11]KOLEGA M,KOVACEVI'CS，CANOVI'CS,et al. Comparison of IOLMaster and ultrasound biometry in preoperative intra ocular lens(IOL)power calculation[J]. Collegium Antropologicum,2015,39(1):233-235.
• [12]成拾明，黄锦海，李岩，等．IOLMaster、Axis-ⅡA型超声和ODM 1000A型眼科超声测量仪测量眼轴长度及前房深度的比较[J]．中华实验眼科杂志，2011,15(11):1023-1027.
• [13]MYLONAS G,SACU S,BUEHL W,et al. Performance of three biometry devices in patients with different grades of age-related cataract[J]. Acta ophthalmologica,2011,89(3):237-241.
• [14]SHENTU X C,CHENG Y L,CHEN Z Q,et al. Differences in intraocular lens power calculation in patients with sub-foveal choroidal neovascularization[J]. International Journal of Ophthalmology,2019,12(1):172-174.
• [15]孙靖，梁四妥，张红．光相干生物测量仪与接触式A型超声测量黄斑水肿患者眼轴长度比较[J]．中华眼底病杂志，2012,28(4):359-362
• [16]KYMIONIS G D,GIARMOUKAKIS A,APOSTOLIDI I K,et al. Optical biometry derived axial length measurements following intravitreal anti-vascular endothelial growth factor treatment for macular edema[J]. Seminars in Ophthalmology,2018,33(4):488-491.
• [17]杨梁燕，袁建树，王育文，等．预留中度近视治疗高度近视合并黄斑退行性病变白内障术后低视力效果观察[J]．现代实用医学，2014. 26(2):214-215.
• [18]张佳晴，罗莉霞．白内障合并高度近视患者术后屈光力预测的研究进展[J]．国际眼科杂志，2019,19(6):929-932.
• [19]KLIJN S,SICAM V,REUS N J. Long-term changes in intraocular lens position and corneal curvature after cataract surgery and their effect on refraction[J]. Journal of Cataract&Refractive Surgery,2016,42(1):35-43.
• [20]竺向佳，常瑞琪，卢奕．不可忽视的高度近视白内障术后屈光误差与屈光漂移[J]．中国眼耳鼻喉科杂志，2018,18(2):130-133.
• [21]韦微，左慧懿，谭少健．超声乳化白内障吸除联合人工晶状体植入术后眼前节参数变化与屈光漂移的相关性分析[J]．中华眼科医学杂志(电子版)，2017,17(4):151-157.
• [22]ATTAS F L,ZADOK D,GERBER Y,et al. Axial length measurement in eyes with diabetic macular edema:a-scan ultrasound versus IOLMaster[J]. Ophthalmology,2007,114(8):1499-1504.
• [23]SUN H J,CHOI K S. Improving intraocular lens power prediction in combined phacoemulsification and vitrectomy in eyes with macular oedema[J]. Acta Ophthalmologica,2011,89(6):575-578.
• [24]KUNAVISARUT P,POOPATTANAKUL P,INTARATED C,et al. Accuracy and reliability of IOL master and A-scan immersion biometry in silicone oil-filled eyes[J]. Eye,2012,26(10):1344-1348.
• [25]KOJIMA T,TAMAOKI A,YOSHIDA N,et al. Evaluation of axial length measurement of the eye using partial coherence interferometry and ultrasound in cases of macular disease[J]. Ophthalmology,2010,117(9):1750-1754.

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