匹鲁卡品诱导下人工晶状体光学面在眼内移动的临床研究

Clinical observation of intraocular lens optic movement induced by pilocarpine

目的 观察2％匹鲁卡品诱导不同设计的单焦点人工晶状体（Intraocular Lens，IOL）光学面的移动，探讨伪凋节（pseudoaccommodation）产生的机制。方法 收集43例IOL眼患者，应用移近法测量其调节幅度，使用前段光学相干断层扫描仪（Anterior Chamber Optical Coherence Tomography，ACOCT）测量患眼最佳远视力矫正下和2％匹鲁卡品诱导状态下前房深度的变化。结果 移近法测量的SA60AT、MA6CBM和AKreos三种IOL平均调节幅度分别为1．98±0．64D，2．07±58D，2．15±0．54D，差异无统计学意义。ACOCT测量的最佳远视力矫正和2％匹鲁卡品诱导两种状态下SA60AT、MA60BM和Akreos三种IOL平均前移幅度分别为（0．35±0．25）mm（t=6．25p=0．00），（-0．02±0．04）mm（t=-1．55p=0．12），（0．28±0．10）mm（t=8．37 p=0．00）。三种IOL调节幅度与药物诱导下的IOL移动幅度不相关（r=0．087，0．337，0．428p=0．722，0．342，0．218）。结论 药物诱导下板状襻（Akreos）和一片式（SA60AT）设计的IOL光学面可以发生前移，三片式（MA60BM）设计的IOL光学面没有前移。

Objective Observe the intraocular lens movement,measured as a change in anterior chamber depth （ACD） induced by 2% pilocarpine,to study the mechanism of pseudoaccommodation. Methods 43 eyes with monofocal intraocular lens were included,push-up method was used to measure accommodative amplitude. The ACD and pupil diameter were measured using anterior chamber optical coherence tomography when eyes in the conditions of the best corrected distance vision acuity and conditions under 2% pilocarpine.Results The mean accommodative amplitude measured by push-up method of SA60AT, MA60BM, Akreos IOL were 1.98 ± 0.64D, 2.07 ±0.58 D, 2.16 ± 0.54 D, SA60AT IOL（one piece）and Akreos IOL（plate-haptic）showed a forward movement （SA60AT IOL 0.35±0.25mm, Akreos IOL 0.28±0.10mm）; MA60BM IOL（3-piece）showed no change m ACD. In each group, there Was no correlation between Accommodative amplitude and IOL movement amplitude induced by 2% pilocarpine（r=0.087, 0.337, 0.428 p=0.722, 0.342, 0.218）. Conclusion One piece IOL and plate-haptic IOLcan move forward induced by 2% pilocarpine. But 3-piece IOL showed no change in ACD.