ICL-晶状体间距和虹膜张力对ICL术后并发白内障影响研究

The research on the significance of both the distances from ICL to lens and iris tension in complicated cataract after ICL implant

目的研究ICL（Implantable contact lens，ICL）晶状体的距离以及虹膜张力在ICL并发白内障中的意义。方法临床病例对照研究。对2006年8月至2012年8月在深圳市眼科医院就诊患者，采用眼前段全景OCT观察并发白内障患者ICL在后房的位置变化，并采用Independent-Samples T Test与无并发白内障的患者进行比较。结果瞳孔散大后，ICL并发白内障患者的ICL周边部距晶状体前表面最小间距（D3值）为（77．75±8．70）μm，变化范围69．05～86．45μm；ICL合并正常晶状体患者的D3值为（145．68±28．88）μm，变化范围116．8-174．56μm，二者进行Independent-Samples T Test，P=0．001〈0．05，差异有统计学意义。ICL并发白内障患者D2-D1值（虹膜张力差）为（321±21.31）μm，变化范围299．69-342．31μm；ICL术后透明晶状体患者的D2-D1值为（286．32±60．46）μm，变化范围225．86-346．78μm，P=0．03〈0．05，差异有统计学意义。结论ICL周边部距晶状体前表面的最小间距（D3值）和虹膜张力差（D2-D1值）在并发性白内障的发病机制中具有重要作用。D3值大于116．8μm是相对安全的间距，发生并发性白内障的几率较小；当D3小于86．45μm和D2-D1值大于299．69μm时，并发性白内障的几率增大。

Objective To study the significance of the distances from ICL to lens and iris ten- sion in complicated cataract of ICL. Methods Based on the position changes of ICL in the posteri- or chamber with complicated cataract patients and with no complicated cataract patients with anterior segment and full-field optical coherence tomography, the data of the two group were analysed with the Independent-samples T Test. Results Under mydriasis, the average minimum distance between ICL peripheral part and the front surface of lens （D3 value） in study group was （77,75 ± 8.70）μm, ranged from 69.05 to 86.45μm, and （145.68±28.88）μm, ranged from 116.8 to 174.56μm in control group. The Independent-samples T Test showed the highly significant difference statistically between them （P =0.03〈0.05）; The iris tension differential （D2-Dlvalue） was respectively （321±21.31）μm（range 299.69 to 342.315μm） and （286.32±60.46）μm （range 225.86 to 346.78μm） in study group and control group. A statistical comparison between the two groups is significant with regard to iris tension （P =0.03〈0.05） . Conclusions The minimum distance between the peripheral part of ICL and the front surface of lens （D3 value） and the iris tension （D2-D1 value） is of great significance in the etiology of complicated cataract after ICL implant. D3 value of more than l16.8μm is relative- ly safe and not easy to cause lens opacity. But D3 value less than 86.45μm and D2-D1 value more than 299.69μm would increase the chance of contact between the ICL and the lens and then the oc- currence of post-operative cataract.