伴后巩膜葡萄肿的高度近视白内障患者人工晶状体屈光度测算

Analysis of intraocular lens power calculation for cataract patients with high myopia and posterior scleral staphyloma

背景白内障术前人工晶状体（IOL）屈光度的准确测算是术后恢复良好视功能的关键，尤其是对伴后巩膜葡萄肿的高度近视白内障患者。目的对比分析IOLMaster和接触式A型超声两种生物测量方法测算的伴后巩膜葡萄肿的高度近视白内障患者IOL屈光度结果，并对比不同IOL屈光度计算公式的准确性。方法收集2008年8月至2009年2月在天津医科大学眼科医院行白内障超声乳化联合IOL植入术伴后巩膜葡萄肿的高度近视患者28例41眼，术前分别用IOLMaster和接触式A型超声联合手动角膜曲率计测量患眼的生物参数，并根据SRK-Ⅱ、SRK—T、Haigis、HofferQ、Holladay1公式分别计算IOLMaster和接触式A型超声联合手动角膜曲率计测量的IOL屈光度的结果，术后3个月检查患者的屈光状态，评价预测的精确性。结果IOLMaster和接触式A型超声测得的眼轴长度分别为（28．9±2．4）mm和（28．7±2．4）mm，前房深度分别为（3．3±O．4）mm和（2．9±0．6）mm，差异均有统计学意义（P=0．005、0．000），而IOLMaster与手动角膜曲率计测得的角膜曲率分别为（44．7±1．7）D和（44．7±1．6）D，差异无统计学意义（P=0．398）。应用IOLMaster生物测量方法时，SRK／T、Haigis公式较准确；应用接触式A型超声联合手动角膜曲率计生物测量方法时，Holladay1、HofferQ、Haigis公式较准确，平均绝对屈光误差（MAE）较为接近。结论对于伴后巩膜葡萄肿的高度近视白内障患者，应用IOLMaster生物测量方法推荐使用SRK／T、Haigis公式；应用接触式A型超声联合手动角膜曲率计生物测量方法推荐使用Holladay1、HofierQ、Haigis公式。

Background The accurate calculation of intraocular lens （IOL） power is essential for attaining the desired refractive outcome after cataract surgery, especially for patients with high myopia and posterior scleral staphyloma. Objective This study was to evaluate the clinical feasibility of IOL Master compared with contact A-scan in cataract patients with high myopia and posterior scleral staphyloma,then compare the accuracy of different IOL power calculation formulas. Methods This was a prospective case control clinical research. Fourty-one eyes with age-related cataract of 28 patients underwent phacoemulsification with monofocal foldable IOL implantation in Tianjin Medical University Eye Hospital were involved,who were all high myopia with posterior scleral staphyloma. Preoperative measurement was measured with IOL Master as well as with contact A-scan and manual keratometry. IOL power was calculated according to the SRK- Ⅱ ,SRK-T, Haigis, Holler Q, Holladay 1 formulas. The refractive outcome was followed-up 3 months after operation. Results The difference was significant between the 2 methods in axial length （AL） and anterior chamber depth （ ACD ） measurement （ P = 0. 005, 0. 000 ） ; In corneal curvature measurement,there was no significant difference between them （ P = 0. 398 ）. When mean absolute refractive error （MAE） was divided by ±1.00 D,The SRK/T and Haigis formula performed better than other formulas measured by IOL Master;The Holladay 1,Hoffer Q and Haigis formula performed better than other formulas measured by contact A-scan combined with manual keratometry,respectively. Conclusions For cataract patients with high myopia and posterior scleral staphyloma, SRK/T and Haigis formula were recommended when employing IOL Master; whereas when using contact A-scan combined with manual keratomctry,we prefer Holladay 1 , Hoffer Q or Haigis formula.