有晶状体眼后房型人工晶状体植入术前模拟拱高与术后真实拱高的比较

Comparative analysis of preoperative simulated vaults and postoperative real vaults in implantable collamer lens implantation

目的探讨50MHz全景超声生物显微镜（UBM）对行有晶状体眼后房型人工晶状体（PPC—ICL）植入术矫正高度近视患者进行术前模拟拱高（SV），并分析其与术后实际拱高的一致性和相关性。方法自身对照研究。选取2014年5月至2014年7月至复旦大学附属眼耳鼻喉科医院视光中心拟行PPC—ICL植入术的高度近视患者21例（37眼），年龄（30．0±9．0）岁，等效球镜度（SE）（-15．60±5．74）D。术前根据检查确定欲植入PPC．ICL的屈光度和尺寸后，运用Compact Touch STS UBM模拟得到植入术后的眼内图像和位置，并测量其SV，术后1个月再次分别运用Compact Touch STS UBM及Pentacam测量真实拱高，分别记录为VUBM及Ventarcm.分别运用Pearson相关与Bland—Altman分析两两变量间的相关性及一致性。结果SV与VUBA、VPentarum间差异存在统计学意义（t=6．660、9．658，P〈0．01）。SV与VUBM、VPetacam均存在一定的相关性（r=0．508、0．557，P〈0．01）。用Bland—Altman对三者进行一致性分析，VUBM与VPetacam一致性最强，95％一致性区间（95％LoA）为-0．07-0．22mm，而SV与VUBM、VPetacam的临床一致性并不显著（95％LoA分别为-0．19—0．66mm、-0．07-0．70mm）。结论Compact Touch STS UBM与Pentaeam对高度近视患者PPC-ICL植入术后拱高的测量在临床上可相互替代，但Compact Touch STS UBM术前模拟PPC—ICL植入后的SV与术后真实拱高尚有一定差距，需要进一步临床探索。

Objective To investigate the agreement and correlation between preoperative simulated vaults （SV） measured by 50 MHz full-scale ultrasound biomicroscope and postoperative real vaults in phakic posterior chamber implantable eollamer lens （PPC-ICL） implantation. Methods In this self-control study, 21 high myopia patients （37 eyes） undergoing PPC-ICL implantation were included at the Eye and ENT Hospital of Fudan University from May to July in 2014. The mean age was 30.0±9.0 years and the mean spherical equivalent was -15.60±5.74 D. Based on the preoperative examination, the correct diopters and sizes of the PPC-ICL can be determined. Then the simulated postoperative images, simulated lens, positions and SV were achieved using a Compact Touch STS UBM. One month after implantation, the real vaults were measured by UBM and Pentaeam, which were recorded as VUSM and Vp, respectively. The correlation and agreement for the three vaults were analyzed with Pearson correlation analysis and Bland-Altman, respectively. Results SV, differed significantly from VUBM and VPetacam （t=6.660, 9.658, P〈0.01）. Correlation analysis showed that there were moderate correlations between SV and VUBM, SV and VPetacam （r=0.508, 0.557, P〈0.01）. For the postoperative vauhs, the agreement between the vaults measured by the Compact Touch STS UBM and those measured by Pentacam was strongest [95% Limit of Agreements （LoA）=-0.07-0.22 mm]. In contrast, the 95% LoA showed clinically significant differences between SV and Vosu and between SV and VPetacam （95% LoA=-0.19-0.66 mm, -0.07-0.70 mm）. Conclusion Compact Touch STS UBM can replace Pentacam clinically in postoperative vault measurements. There is still a certain gap between the SV measured by the Compact Touch STS UBM and the actual postoperative vaults.