光学相干生物测量仪联合晶状体浑浊测量仪检查对浅前房白内障手术的预测性研究

Application of IOLmaster and opacity lensmeter in evaluation of operations on patients with cataractand shallow anterior chamber

目的对白内障合并浅前房者，采用光学相干生物测量仪（IOLmaster）联合晶状体浑浊测量仪（OLM）检查，观察其对手术适应症及时机的预测准确性。方法随机收集白内障合并浅前房106例（128眼）。根据前房深浅分为轻度浅前房和高危浅前房。依据晶状体浑浊程度分为轻、中、重度浑浊。部分患者接受了超声乳化人工晶状体植人手术，或激光周边虹膜成形术。随访2年观察眼部情况、视力、眼压等。结果未手术组：轻度浅前房和高危浅前房者随访2a内的前房深度进行性变浅，眼压进行性升高（P〈0．05）；随访2年内，随着晶状体浑浊程度进行性加重，晶状体重度浑浊者的中央前房深度浅于晶状体轻、中度浑浊者（P〈0．05），同时，眼压高于晶状体轻、中度浑浊者（P〈0．05）。白内障手术组：随访2年高眼压发生率（4．88％）低于未接受手术治疗者（41．30％）（P〈0．05）；术后的中央前房深度深于术前（P〈0．05），也深于未接受手术者（P〈0．05）；术后的眼压低于术前（P〈0．05），也低于未接受手术者（P〈0．05）；不同程度浅前房者的视力都明显高于术前（P〈0．05），但术后高危浅前房组的视力低于轻度浅前房组（P〈0．05）。激光治疗组：轻度浅前房者，1年的眼压与术前相比差异无统计学意义（P〉0．05）；高危浅前房者，1年的眼压高于术前（P〈0．05）。结论IOLmaster联合OLM检查能够客观评估白内障合并浅前房者的病情变化，确定手术时机。及早进行白内障手术是治疗此类患眼的关键所在，激光治疗远期疗效不确切。

Objective To study the application of IOLmaster and opacity lensmeter（OLM） in evaluation of operations on patients with cataract and shallow anterior chamber. Methods 106 patients （ 128 eyes） with cataract and shallow anterior chamber were divided into mild and severe groups by anterior chamber depth, mild ,moderate and severe groups by lens density. Part of the patients received phacoemulsification or laser treatment. They were observed and analyzed for 2 years. Results （ 1 ） No operation group ：The conditions of anterior chamber depth and intraocular pressure（IOP） became more serious in mild and severe anterior chamber depth groups during the 2 years （P 〈 0. 05 ） ;The conditions of shallow anterior chamber and IOP in severe lens density group were more serious than that in the mild and morderate groups during the 2 years （ P 〈 0. 05 ）. （ 2 ） Cataract surgery groups ： The high IOP rate of patients with cataract surgery （ 4.88 % ） was lower than that of patient without surgery treatment （41.30%） （P 〈 0. 05 ） ;The anterior chamber depth of patients with cataract surgery was deeper than the preoperative one （ P 〈 0. 05 ） and that of patients without surgery treatment （P 〈 0.05 ） ;The postoperative IOP was lower than the preoperative one （P 〈 0.05 ）. It was also lower than the lOP in the group without surgery treatment （P 〈 0. 05）. The best corrected visual acuity （BCVA） of all patients improved after surgery （P 〈 0. 05 ）, while the BCVA of patients in severe anterior chamber group after operation was lower than that in mild anterior chamber （P 〈 0.05 ）. （3） Laser treatmentgroup ： One years later, lOP of patients with laser treatment in mild anterior chamber group was no significant change （P 〉 0.05）. While IOPs of patients with laser treamtnet in severe anterior chamber group got worse in one year （ P 〈 0. 05 ） though laser treatment successfully. Conclusion IOLmaster and OLM can offer the assessing of progression of the patients with cataract and shallow anterior chamber. Earlier surgery for cataract is more effective than laser treatment.