【摘要】  目的:應(yīng)用三維光學(xué)相干斷層掃描儀觀察白內(nèi)障術(shù)后黃斑區(qū)結(jié)構(gòu)的影像學(xué)特征。方法:回顧性分析我院2009��11/2010��02行超聲乳化白內(nèi)障手術(shù)且術(shù)中無并發(fā)癥的32例46眼單純老年性白內(nèi)障患者，記錄術(shù)后視力、眼前段和眼底情況，術(shù)后1mo行三維光學(xué)相干斷層掃描(Topcon3D OCT��1000)檢測。結(jié)果:白內(nèi)障患者46眼均成功施行超聲乳化吸除術(shù)，術(shù)后視力均有不同程度提高;術(shù)后1mo從三維OCT中未發(fā)現(xiàn)明顯黃斑區(qū)結(jié)構(gòu)的改變且檢測到黃斑中心凹視網(wǎng)膜平均厚度(CMT)為(217.34±36.15)μm，較正常同年齡人群組黃斑中心凹視網(wǎng)膜平均厚度CMT為(195.87±40.87)μm略增加，但兩者經(jīng)統(tǒng)計學(xué)處理未見明顯差異(P=0.284);少數(shù)視力和視功能恢復(fù)略差的患者其OCT中表現(xiàn)為光感受器內(nèi)外節(jié)連接(IS/OS)層的連續(xù)性及視網(wǎng)膜色素上皮(RPE)的完整性欠佳。結(jié)論:無全身及眼部其他疾病的老年性白內(nèi)障患者,術(shù)后1mo黃斑區(qū)結(jié)構(gòu)基本與正常人群相同，部分患者出現(xiàn)視網(wǎng)膜后極部IS/OS和RPE連續(xù)性和完整性的輕度變化，因而使術(shù)后患者視力尤其是視功能質(zhì)量的提高受到影響。

【關(guān)鍵詞】  超聲乳化/白內(nèi)障;視力/視功能;光學(xué)相干斷層掃描法律論文發(fā)表

　　AbstractAIM: To eva luate the imaging features of the macular after phacoemulsification cataract surgery by spectral�瞕omain optical coherence tomography(SD�睴CT).METHODS:A retrospective series case study. 46 eyes with simple age�瞨elated cataract who had phacoemulsification from Nov.2009 to Feb.2010 in our hospital without any complications during operation were included in this study. Visual acuity, slit�瞝amp examination and fundus were checked. SD�睴CT(Topcon 3D�睴CT��1000) was used to check retinal structure at 1 month after surgery.�rRESULTS: Successful cataract surgery was performed in all eyes with postoperative best�瞔orrected visual acuity(BCVA) improved.SD�睴CT showed no significant change of the macular thickness except for slight increase of the central macular thickness, which was 217.34±36.15μm compared with195.87±40.87μm of normal people at the same age. There was no statistical difference between surgical group and normal people group. However, the slight abnormal at continuity of the IS/OS layer and integrity of the RPE layer appeared in some poor visual acuity and visual function recovery patients.CONCLUSION: The macular thickness compared with normal people has no significant change after phacoemulsification in simple age�瞨elated cataract patients without other complication before surgery. Some patients at 1 month after surgery with slight poor visual acuity and visual function is probably due to the abnormal of continuity of the IS/OS layer and integrity of the RPE layer.法律論文發(fā)表

　�rKEYWORDS: phacoemulsification/cataract; visual acuity/ function; optical coherence tomography

:　　0引言

　　隨著超聲乳化白內(nèi)障手術(shù)技術(shù)及設(shè)備的不斷完善，手術(shù)并發(fā)癥明顯減少，手術(shù)效果顯著提高[1]。但是，有些術(shù)前視功能預(yù)測良好、術(shù)后眼前部沒有明顯異常的患者并不能獲得滿意的視覺效果[2] ，為了探究其原因，我們對32例46眼白內(nèi)障患者行超聲乳化吸除術(shù)后1mo進行三維光學(xué)相干斷層掃描檢查，觀察黃斑區(qū)的結(jié)構(gòu)特征，分析影響視力恢復(fù)的相關(guān)因素。

　　1對象和方法

　　1.1對象 回顧性分析2009��11/2010��02在我院行超聲乳化吸除手術(shù)的32例46眼老年性白內(nèi)障患者，其中男18例25眼，女14例21眼;年齡47～81(平均69)歲;術(shù)前視力指數(shù)/眼前～0.4，晶狀體核硬度Ⅰ～Ⅳ級;46眼中均無全身及眼部其他疾病。術(shù)后1mo所有患者均行眼部常規(guī)檢查，包括最佳矯正視力、眼壓、裂隙燈顯微鏡、散瞳后直間接檢眼鏡及三維光學(xué)相干斷層掃描(Topcon 3D OCT��1000,日本Topcon公司)檢測。法律論文發(fā)表

　　1.2方法 散瞳后對所有患眼視網(wǎng)膜黃斑區(qū)進行3D�睴CT檢測，掃描模式選用512×128，掃描范圍為后極部 6.00mm×6.00mm，掃描速度27000次A掃描/s，探測深度2.3mm，軸向分辨率5μm;結(jié)合相應(yīng)的掃描彩色眼底照片，測量和分析黃斑中心凹部位視網(wǎng)膜的厚度和結(jié)構(gòu)變化。充分散瞳后眼周阻滯麻醉，46眼均做上方透明角膜隧道切口，黏彈劑下連續(xù)環(huán)形撕囊，水分離后采用超聲乳化儀(Legacy2000，美國愛爾康公司)用攔截劈裂法超聲乳化晶狀體核，抽吸晶狀體皮質(zhì)，沿后囊膜注入黏彈劑，通過推注器植入疏水性丙烯酸酯一片式折疊式人工晶狀體(MA60MA，Alcon公司)到位，吸凈前房及人工晶狀體后面黏彈劑，水密切口。術(shù)畢結(jié)膜下給予抗菌消炎處理，手術(shù)均順利完成，術(shù)中無并發(fā)癥;術(shù)后典必殊眼液滴眼，4次/d，持續(xù)至術(shù)后15d。手術(shù)均由同一人操作，隨訪1～3mo。

　　統(tǒng)計學(xué)分析：所有數(shù)據(jù)均采用SAS 8.2統(tǒng)計軟件處理，選用樣本均數(shù)與總體均數(shù)比較的t檢驗分析治療組術(shù)后黃斑中心凹視網(wǎng)膜平均厚度和正常同年齡人群組的黃斑中心凹視網(wǎng)膜平均厚度之間的差異。P<0.05為差異有統(tǒng)計學(xué)意義。

　　2結(jié)果

　　2.1視力 所選32例46眼老年性白內(nèi)障患者的視力在術(shù)后1mo檢查時較術(shù)前均有不同程度的提高，術(shù)后1mo最佳矯正視力≥0.6者有36眼(78%)，0.3～0.5者有10眼(22%)。

　　2.2眼部情況 術(shù)后1mo 46眼角膜透明，無炎癥反應(yīng)，人工晶狀體位置良好，眼底鏡下未發(fā)現(xiàn)明顯黃斑區(qū)病變。

　　2.3光學(xué)相干斷層掃描(3D�睴CT��